Mr. W. is a 75 year old Chinese-American male who presents with vague and multiple physical complaints he reports he has had for several weeks. Prior to this he had been in good health and would come in only for periodic physical exams. His son tells you he has been complaining of “heart pain”, indigestion, and weakness. He had been seeing the herbalist, but has continued to complain to his son.
The patient does not speak much English and his son interprets for him. During the interview you find out that Mrs. W., his wife of 50 years, died last year. His son is busy and sees him about once a month and will be moving to a job in another state. Your exam, laboratory and diagnostic tests are normal. On a return visit, you bring up the possibility that Mr. W. may be depressed. The son and the patient get very upset and vehemently deny any depression. The patient states that he is sick, not crazy.