Unless their true fears are addressed, diagnostic tests may leave them more anxious than before

Reassuring patients who have unwarranted concerns that they are seriously ill is one of the commonest medical tasks. But the dearth of research on the subject suggests either that dealing with such patients is not a problem or that it is one best left to clinical judgment. In this issue of the BMJ (p 329), McDonald and colleagues report that many patients continue to be anxious about their heart despite being informed of a normal result from echocardiology.1 Three quarters of the patients in their sample were referred for exclusion of heart disease after routine examination for insurance or employment, suggesting that unjustified concern about ill health is often iatrogenic.

Other studies have drawn attention to difficulties in reassuring patients. Mayou reports from a prospective study that one third of patients in a cardiac clinic who were told that there was nothing wrong with their hearts expressed fears about cardiac disease three months later.2 In a similarly designed study, 40% of a sample of patients referred to neurologists …