This morning I get a housecall requested by the district nurses, who have visited a lady 5 days out from her amputation of left leg. This is the culmination of no less than 17 previous operations attempting to save her leg following a car crash many years before. The report is of "phantom limb pain" and constipation, but when I ring her she sounds fine, says the pain relief strategy is working and has moved her bowels only 2 days ago. All in all she seems remarkably sanguine about her plight; indeed on further questioning of the nurses, it is precisely this they are concerned about.
I begin to wonder if she isn't a case of "la belle indifference" a psychiatric condition where the patient maintains a breezy and unconcerned attitude to their condition, however serious that may be. If so, I'm not sure quite what to do: tell her to be more worried? All I do know is that I'd rather be faced with this scenario than the reverse, and this of course is much more common, where someone whose anxiety level far exceeds the seriousness of the situation. It's certainly less work for the GP!
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