If you've been practicing medicine for more than a week, you've experienced it. You enter an exam room to find an apparently healthy middle-aged woman who woke up this morning with a headache. She wonders what should be done. After all, her co-worker was having headaches and had a CT scan to find the cause. Or you're seeing a young man who has a cold for the second time this season. He heard somewhere that frequent colds can be caused by a suppressed immune system. Could that be his problem? Then there is the patient who dashes into your office with every ache, pain, spasm, twinge, twitch, or itch — just to be sure. Welcome to the world of the "worried well."

While some worried-well patients in fact have hypochondria —defined as "a morbid concern about one's own health ... a delusion that one is suffering from some disease for which no physical basis is evident" — many have less severe, more intermittent worries about their health. Emotional distress or depression may play a role as well.

Family physician Joseph Ewing, MD, who practices in Las Cruces, N.M., sees his share of the worried well. "These are basically normal people with many of the same fears we all have," he says. "They run across all socioeconomic levels but, interestingly, I find it to be more common in people who have time to worry. Someone who is working very hard to make a living and support a family gets a bellyache, but may not have the luxury of running to the doctor."

 Patients with health anxiety often present with symptoms of pain or discomfort — sometimes vague, other times quite specific in nature. Also common is concern about cancer, heart disease, or symptoms related to a condition that a friend or family member has suffered through or died from recently.

"A key distinction in these patients is that they don't recognize that symptoms are normal. They assume that every complaint means something is wrong and needs a test. If these patients have any anxiety or depression, then it gets magnified," says Robert C. Smith, MD, professor of medicine and psychiatry at Michigan State University. "Aches and pains are normal — it's when [patients] start to become high utilizers that it becomes a problem. That's a time to perhaps look for some underlying depression."