What the Chart Doesn't Show: Untangling Psychiatric and Medical Symptoms in Cancer Survivors by Dr. Guy Maytal, MD

YOUR SPEAKER

Dr. Guy Maytal, MD
Psychiatrist · Chief Medical Officer, Forge Health · Clinical Associate Professor of Psychiatry, Weill Cornell Medicine · formerly of MGH and NewYork-Presbyterian

"A diagnosis is a hypothesis, not a description."

FIVE REAL CASES

Each patient arrived with a label already in the chart. Dr. Maytal showed where the evaluation led.

1. "Treatment-resistant depression" became immune checkpoint inhibitor hypophysitis
2. "She keeps asking for scans" became health anxiety layered on fear of recurrence
3. "PHQ-9 is 15, start an SSRI" became anthracycline cardiomyopathy and demoralization
4. "Non-adherent with surveillance" became PTSD from the radiation mask
5. "Please treat his mania" became steroid mania plus tacrolimus-associated PRES

SIX CLINICAL TOOLS

• Three red flags for a hidden medical cause
• The NCCN three-domain evaluation: medical, psychiatric, social
• The amplification loop behind repeated scans and reassurance
• The anhedonia test: "Is there anything you still enjoy?"
• Which way is the fear facing? PTSD faces the past, fear of recurrence faces the future
• The EBMT rule for new neuropsychiatric symptoms after transplant

TAKE-HOME POINTS

1. Keep the diagnosis open to revision, even when it is already written in the chart.
2. A symptom can have medical and psychiatric causes at the same time.
3. Work in parallel, not in sequence: look for medical causes while you treat psychiatric symptoms.
4. Ask how much of each, and who you need at the table to help you tell.

WHO THIS IS FOR

• Oncologists and survivorship physicians who see patients struggling after treatment
• Primary care physicians who inherit survivorship patients
• Psychiatrists, psychologists, therapists and social workers caring for survivors

THE REPLAY AND THE HANDOUT

Watch the full talk on YouTube, and download Dr. Maytal's handout with the five cases, the six tools and 80 references.