Sunday, January 20, 2008

Ulysses syndrome

Ulysses syndrome : "What are the two hardest things to do in medicine? To say nothing (or 'I don't know') and to do nothing. We have all felt parents' disappointment at the end of a consultation. So, rather than discharge their child, we offer a follow-up appointment, hoping that by then the parents will be more accepting of the situation or that they will be seen by a different doctor. However well meaning our action may be, it medicalises the child's condition: the parents may well feel that their child must have a serious problem because he or she is 'under' a specialist.

We might also request another test, and risk inducing 'Ulysses syndrome.' Ulysses fought in the Trojan war but afterwards took 10 years, with many dangerous and often pointless adventures, before he got back to where he had started. Patients with Ulysses syndrome find themselves caught in a web of further investigations, referrals, and sometimes treatment before finally being recognised as healthy, which they were in the first place. Ulysses syndrome is a side effect of unnecessary and inappropriate investigations or wrong interpretation of results. It was first described 30 years ago,1 and the number of tests available is now much greater. With greater choice comes greater responsibility and the need for greater discernment. Otherwise we may condemn our patients to a similar ordeal."

I just wish more doctors ( and their patients) became aware of what they are potentially subjecting their patients to when they order tests. Tests are meant to reassure - but they often end up as a "wild-goose chase" - and cause more distress and anguish ! Masterly inactivity is sometimes the best course of action.

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