Sheep in wolf's clothing: a case report

• Autor(a) principal: Ribeiro, Andreia Soares Teles
• Data de Publicação: 2020
• Outros Autores: Freire, Gonçalo, Araújo, Ricardo Simões de
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Brasileira de Medicina de Família e Comunidade (Online)
• Texto Completo: https://www.rbmfc.org.br/rbmfc/article/view/2645
• topic: Leiomyomatosis; Multiple Pulmonary Nodules; Primary Health Care.; Leiomiomatosis; Nódulos Pulmonares Múltiples; Atención Primaria de Salud.; Leiomiomatose; Nódulos Pulmonares Múltiplos; Atenção Primária à Saúde.

Introduction: When a patient has a medical appointment, they already have a pre-defined idea of their health problem. This idea is influenced by their previous experience, local culture and family support. Case Description: 48-year-old female, former smoker. She reveals a personal history of uterine leiomyoma excision 18 years ago. She turns to her doctor complaining of cough for the last four months. A chest computed tomography was ordered, in which nodular formations were identified, suggestive of metastasis. An urgent referral was made to a pulmonology consultation, where a biopsy was requested, which the patient refused to perform. After a family assessment, the patient realized that her previous life experience generated her fear. The patient ended up performing the biopsy that revealed a leiomyoma pattern. The diagnosis of benign metastatic leiomyomatosis secondary to uterine fibroid excision was made. Conclusion: The “illness” understood by patients will influence how they will manage their disease and their malaise. In the consultation there is a confrontation between the patient’s fears and the diagnostic uncertainties of the physician. In such cases, the family doctor should not assume a paternalistic position of decision, but should empower patients to make a conscious and informed choice.