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Editorials |

Listening to Our Patients

Marc H. Lavietes, MD, FCCP
Author and Funding Information

Affiliations: Newark, NJ
 ,  Dr. Lavietes is Associate Professor of Medicine, the New Jersey Medical School.

Correspondence to: Marc H. Lavietes, MD, FCCP. UMD-NJ Medical School I-354, 100 Bergen St, Newark, NJ 07103-2406; e-mail: lavietmh@umdnj.edu



Chest. 2005;127(6):1877-1878. doi:10.1378/chest.127.6.1877
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As physicians, we are taught early in our careers that our initial medical history and physical examination provide our most important diagnostic information. Laboratory data follow. They serve both to confirm our diagnostic impressions and to quantify the extent of the disease state. Surveys12 of asthmatic patients, however, have demonstrated that it is very difficult to ascertain the severity of a person’s illness from a verbal description of symptoms. Further observations in asthmatic subjects indicate that our patients’ personalities influence the magnitude or intensity of the symptoms they associate with their asthma. Asthmatic patients who score high on either the hypochondriasis or somatization scales, for example, report high levels of dyspnea to be associated with only mild or moderate degrees of airway dysfunction, either during an attack or when stable.34 By contrast, those patients scoring low on these scales tend to minimize the discomfort they associate with severe airway obstruction. Thus, the examining physician may gain some insight into the degree of airway dysfunction in asthmatic patients from their verbal history only if the physician is able to factor a sense of the patient’s tendency to exaggerate or minimize symptoms into the clinical assessment.

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