I just laughed out loud in the library reading this piece from the NEJM :

Words never seem more needless to a busy resident than those elicited from a somatizing patient during a complete review of systems. All the compulsiveness nurtured in medical school evaporates before the onslaught of bewildering trivial complaints that have presumably found, finally, a sympathetic ear. How to shut off the torrent of words?

The conventional strategy is to ask questions that have simple yes-or-no answers, but this rarely hinders the determined somatizer from expanding a yes response into an intricate account of the details of his or her belly pain or dizziness. Long ago, a creative fellow resident invented the only effective method I know of for dealing with a patient with an all-positive review of systems, though I hesitate to recommend it. We called it the “Corning couplets” in his honor. Typical couplets might be “Have you ever had constipation or syphilis?” and “Do you have headaches or lice?”

[via kevinmd ]

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