Patients differ in how they describe their complaints.
This individualizing examination of a disease case, for which I am giving only general instructions here (and from which the disease examiner should retain only what is applicable to each single case) demands nothing of the medical-art practitioner except freedom from bias and healthy senses, attention while observing and fidelity in recording the image of the disease.
148 A pure fabrication of befallments and ailments will never indeed be met with in hypochondriacs, even the most insufferable ones. This is demonstrated by a comparison of the ailments they complain of at different times while the physician gives them nothing at all or something unmedicinal [i.e. , a placebo]. However, something must be deducted from their exaggerations, or at least the strength of their expressions should be attributed to their excessive feeling. The high pitch of their expressions about their sufferings becomes, in itself, a significant symptom in the remaining set of symptoms from which the image of the disease is to be composed. It is a different matter with the insane and the willful fabricators of disease.