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Do Investigations Reassure Patients with No Organic Pathology?
  1. Louise Howard*,
  2. Simon Wessely
  1. *Health Services Research Department and
  2. Department of Psychological Medicine, PO 29, Institute of Psychiatry, De Crespigny Park, London SE5 8AF; E-mail: *spjelmh{at}iop.kcl.ac.uk and †sphascw{at}iop.kcl.ac.uk

    Abstract

    INTRODUCTION

    Many patients present to neurology outpatient clinics without serious pathology–the classic example is the patient with chronic headache who believes he has a brain tumour. After a history and examination the neurologist is confident of the diagnosis of chronic tension-type headache, but is left not knowing whether to send the patient for a brain scan ‘for reassurance’. Do investigations reassure patients, or do they make them suspect that the doctor is uncertain of the diagnosis, so leading to increased anxiety about an underlying disease?

    THE EVIDENCE BASE

    The literature is conflicting (Howard & Wessely 1996). It is difficult to measure reassurance (there are no specific tests for it!). Asking the patient whether he or she feels reassured is problematic because most patients want to please their doctors. In addition to asking specific questions about the patient’s feelings of reassurance, researchers have therefore resorted to measuring reassurance by using

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