Health: A fatal case of hypochondria. It happens. And it's usually to men

Males often over-play their illnesses - or are females just unsympathet ic?

ACCORDING TO a survey last week, carried out by the makers of Benylin, men are hypochondriacal wimps when compared to women. This is at least in part borne out by personal experience. One subgroup of male patients attending the emergency department where I work are without doubt the worst over-exaggerators of symptoms you could ever come across.

They are the martial arts brigade - karate, judo and the like. As patients, they always attend surrounded by two or three colleagues, who support and half-carry the limping victim through the door. They have usually been kicked by someone - and that person's feet are trained to kill, I am informed. A foot that can break breeze blocks can surely shatter a tibia. But when the injured part is exposed, all you usually find is the tiniest imaginable bruise. It is considered bad form not to provide any treatment to such a patient, and they usually limp out with the medically unnecessary, but culturally mandatory, tubular bandage. But the most stoical group of patients, verging on the masochistic, are also men. Rugby players are well known for having their fractured noses straightened pitch-side before playing on. What is less well recognised is the number that will play on with broken ankles and, on one occasion, train for a season with a potentially fatal unstable neck fracture.

The term "hypochondria" comes from the name of an area of the body called, unsurprisingly, the hypochondrium. It is the part just below the bottom of the ribcage, where the cartilage of the ribs joins the breastbone. It is also the area where many people experience the vague flutterings, aches and twinges often attributed incorrectly to serious disease. Hence the term being adopted to describe anyone who persistently worries about their health, or lends unwarranted significance to their symptoms.

Doctors are reluctanct to tell patients there is absolutely nothing wrong with them, at least until they have been thoroughly investigated. And some patients, even when they have had every test known to medical science, are even more reluctant to accept the diagnosis. This is why a serious case of hypochondriasis can be fatal these days. A patient may be referred initially by their GP to a general surgeon for investigation of "abdominal bloating". The surgeon finds nothing wrong, and refers to a gynaecologist, who decides that the back ache is more significant, and refers on to an orthopaedic surgeon. The orthopod decides to operate on the patient's back, but after all this they still have the problem they started with. So the original surgeon opens up the abdomen to have a look inside, having turned up nothing on X-ray and ultrasound. The patient dies from post- operative complications, and a post-mortem reveals nothing wrong at all, apart from the damage caused by all the surgery and tests. It happens.

One place where male hypochondria certainly can be found is among medical students. I decided at one time that I had the early symptoms of ankylosing spondylitis, a crippling disease that eventually fuses the spine into a solid rod. All I really had was a trapped nerve in the back. And a friend, after a lot of reading, came up with the idea that he had a rare cancer of the lymph glands. His diagnostic skills were a bit more impressive however, because he unfortunately turned out to be right.

From the results of the Benylin survey it seems men over-play their illnesses more than women. Or rather that's what the women thought they did, which is not quite the same thing. Women were asked about male partners' behaviour, and vice versa. Men were more likely to describe their viral upper respiratory tract infections as "flu" and transform themselves into a pathetic shambles, whereas the sensible women just called it a cold and got on with their lives. Another interpretation could be that women are less sympathetic about men's illnesses than men about women, but that doesn't make for such a good story.