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Bill has always been one of my healthiest patients. In his mid-sixties, I see him for annual check-ups and for one minor complaint or another. He is proud of his healthy lifestyle and has an air of invicibility about him. He often rants about how people are lazy and bring illness on themselves.

I've grown accustomed to handing Bill far more reassurance than prescriptions. Until this week, that is, when he pointed to his mid-chest and began to tell me his story.

It was one of those "door-knob" questions, one that I had not effectively elicited as part of the agenda during our recent visit.

"By the way Doc, I should probably tell you what happened to me at the gym the other day, on the exercise bike," Bill said.

"Maybe so," I replied, and sat back down in my chair, ready to listen.

"It wasn't much of anything. Just felt a strange twinge right about here, and a few seconds of dizziness," he went on, pointing to the area just below his sternum.

"Did you feel sweaty or short of breath?" I asked.

"Well, maybe for a second or two. I just want you to tell me there is nothing to worry about."

This was a first for me with Bill. I was actually worried about him. He had come to think of me as someone who always had good news to deliver, and now I had to change my tune. I wasn't sure how he would respond to my heightened concern. I did not want to scare him away and thought it best to probe his feelings a bit further.

"Bill, are you worried that something might be wrong?"

"Honestly Doc, I hate to admit it, but I am concerned."

It was much easier to be completely truthful with Bill after first taking a few minutes to draw him out. I wonder if he will be more likely to follow up for testing, having reached his own conclusion that further evaluation was needed.

I'll have to wait and see.

Jeffrey Millstein

Moorestown, New Jersey