They don't "believe" they are ill. They actually are ill, just not from a parasite infection. The itch is real and causes distress.
There is an ethical problem in offering lab tests to people when you know that most of them do not have parasite infestations. And it doesn't matter what the results are - they will only serve to strengthen the delusion. A negative result will just be interpreted as "science doesn't know how to test these fibres".
We see this very clearly in people with "health anxiety". Imagine a fit and healthy young man who walks into an ER department and says that he's having a heart attack. Traditionally some doctors would have steapped that man to a bunch of machines and talked anout the results, and then said "see? You're not having a heart attack." This attempt at reassurance is distorted hy the mental health problem into "they wouldn't use all these machines and order these blood tests if there was nothing wrong".
The modern method would be to let the person sit with their thoughts for a few moments - "yes, you might be having a heart attack"; to examine the evidence for that and how strongly they feel it ("I am out of breath and my chest feels a bit tight and I'm a bit dizzy"); then to examine other stuff ("I don't have any pain, now that I have been carefully breathing I don't feel as bad. I know that I have an anxiety disorder that can cause me to panic. Maybe this is not a heart attack but a panic attack.")
This sounds trivial but it is strongly effective for a variety of mental health problems.
The problem here being that people who become ill from a real parasite infection are the most likely people to acquire a delusion that exaggerates and extends their symptomatic distress; The feeling of 'formication' is both caused by insects crawling on the skin, and caused psychogenically by the self-reinforcing expectation that insects are crawling on the skin, an expectation that is entirely rational in anyone who has been subject to an infestation. Detecting parasite infection is non-trivial and error-prone.
A family member has enduring beliefs and anxiety about head lice, which drove them to psychosis for a period of six months, causing all sorts of little false beliefs and reactive rituals that persist several years later as a sort of PTSD. The fact that they quite likely had lice at one point that triggered this whole thing, is no longer provable, but if examined without this case history, we would dismiss it as some kind of waste of physician time. It is very hard to convincingly reassure a patient that they 'no longer' have an infestation that they once had, but are still feeling the symptoms of.
The modern method seems a bit irresponsible to me.
It puts the burden on the patient to prove his claim leaving the doctor only well prepared for the most standard of cases.
I just makes me wonder how many people died of real heart attacks because the doctor felt the need to 'leave them with their thoughts' in a time where every second could make the difference between life and death.
I don't doubt there are people that confuse heart attacks with panic attacks and people who are perfectly fine but feign illness in a desperate attempt to seek attention.
There are all kinds of people however that still doesn't justify ignoring people.
You should be doing anything and everything possible to determine if he is really having a heart attack as he claims and once you determine there is no danger with 99.9% certainty and all the tools at your disposal you can ignore him.
This psychoanalysis and profiling bullshit is the last thing you should have to deal with when you honestly believe your life is in danger.
It's not ignoring them, it's providing a more useful and very cheap diagnostic test to handle the likely case where the patient is suffering from something which can respond better to time and patience than poking and prodding.
If the patient was old, morbidly obese, had a history of heart attacks, was scratching at an tingly left arm, or something like this, I'm sure the doc would go ahead with the other tests.
If the patient is young (as stated in the hypothetical) and otherwise in good shape, giving them a second to baseline is completely reasonable and better for them.
It's really easy to tell the differnece between someone having a heart attack and someone having a panic attack.
> There are all kinds of people however that still doesn't justify ignoring people.
You are not ignoring them. You are avoiding unnecessary and potentially harmful diagnostics and treatments, and providing effective appropriate treatment. You are improving the quality of care.
There is an ethical problem in offering lab tests to people when you know that most of them do not have parasite infestations. And it doesn't matter what the results are - they will only serve to strengthen the delusion. A negative result will just be interpreted as "science doesn't know how to test these fibres".
We see this very clearly in people with "health anxiety". Imagine a fit and healthy young man who walks into an ER department and says that he's having a heart attack. Traditionally some doctors would have steapped that man to a bunch of machines and talked anout the results, and then said "see? You're not having a heart attack." This attempt at reassurance is distorted hy the mental health problem into "they wouldn't use all these machines and order these blood tests if there was nothing wrong".
The modern method would be to let the person sit with their thoughts for a few moments - "yes, you might be having a heart attack"; to examine the evidence for that and how strongly they feel it ("I am out of breath and my chest feels a bit tight and I'm a bit dizzy"); then to examine other stuff ("I don't have any pain, now that I have been carefully breathing I don't feel as bad. I know that I have an anxiety disorder that can cause me to panic. Maybe this is not a heart attack but a panic attack.")
This sounds trivial but it is strongly effective for a variety of mental health problems.