"Are you telling me this as a friend or because you want medical advice?"

I have had countless encounters with friends who bring up their recent physical ailments in casual conversation. When this happens, I have to choose which hat I am going to wear: the friend hat or the medical student hat. Consider the following 2 scenarios, both of which start with the same complaint.

Scenario 1

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: "Oh no that's too bad. How are you going to go on holiday then?" *Allows friend to keep moaning*

The downside of this approach: GUILT. Oh, the guilt! Suppose because you did not attempt to assess your friend, she had a delayed diagnosis of something really dramatic and it was all your fault! A recipe for sleepless nights.

Scenario 2

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: Launches in with "How long exactly have you had the headache? Can you point and show me where it hurts most? Do you feel nauseous?" bla bla bla

The downside of this approach: TOTALLY INAPPROPRIATE. Where is the compassion? Where is the empathy? Your friend called you for a little TLC and you and go straight for the jugular! Probably lose a friend or 2.

The Compromise

Friend: "Omg you know I have had this annoying headache last couple of weeks. I can't take it anymore."
Me: "Oh no that's too bad (empathy). Are you telling me this as a friend or because you want medical advice? (safety net)"

Of course even if they decline my pseudo-medical advice, I'm already building a differential diagnosis and structuring the sequence of questions I would ask if I got the opportunity. All medics know we only have non-medic friends so they can be our guinea pigs. I also tend to include some carefully padded screening questions in the following conversation. For example- "Oh let me get that off the floor for you. I'm sure your headache gets worse whenever you bend down...."

The answer: Just ask! 

This improves patient- I mean friend!- satisfaction. And for all friends who do the casual "talk about my problem" thing, just be aware you have triggered a reflex response and we WILL try to assess you without you knowing it.