A patient with hypochondriasis refuses to believe repeated negative tests and insists he has a brain tumor. Which response is most therapeutic?

• A. Set boundaries and involve your case manager so he can help reduce anxiety.
• B. Present reality: you have been seen many times and results were negative.
• C. Encourage expression of feelings.
• D. Respect the patient's wishes and arrange for immediate physician contact.

Answer: (A)

When someone is convinced they have a serious illness despite repeated negative tests, the most therapeutic approach is to establish clear boundaries and involve the case manager to coordinate care. This provides a structured, multidisciplinary plan that can reduce anxiety without reinforcing the fixed belief or encouraging endless testing. By setting limits, you help the patient feel managed and supported, not ambushed or dismissed, while the case manager can arrange appropriate psychosocial support, follow-up, and access to mental health resources as needed.

presenting reality directly can backfire with fixed delusional thinking, often triggering defensiveness and damaging rapport. Encouraging expression of feelings is valuable for emotional processing, but it doesn't address the ongoing anxiety and need for a stable care plan. Respecting wishes and arranging immediate physician contact, while seemingly compassionate, may unnecessarily reinforce the insistence on ongoing evaluations and fail to provide the coordinated support that helps reduce the fixation over time.