Patient trying to tell something else: severe stress Dduring COVID-19 pandemic

**The COVID-19 pandemic and the resulting economic recession have negatively affected many people's mental health due to isolation, burnout, or economic crisis resulting in job loss linked to poor mental health outcomes (Panchal et al., 2021). **The following case study illustrates the clinical role of primary care physicians to consider a 'hidden agenda' when a patient presenting with signs or symptoms of undifferentiated illness investigated to be normal. The symptoms were persistent, representing a plea for help of underlying stress, worry, and concerns. **This case described a young working adult man who suffers from severe stress presented with heart disease symptoms. He has extensive responsibility during this pandemic and on follow-up for hypertension and dyslipidaemia. Despite non�significant investigations related to heart disease at the cardiology clinic, he returned with the same intense unresolved symptoms. Depression Anxiety Stress Scales 21-item (DASS-21) (Lovibond et al., 1995) revealed a very high score for stress and anxiety. **Stress management counselling includes detecting the underlying stress (mainly by the impact of the COVID-19 pandemic), behavioural changes, stress coping skills and spiritual empowerment. Reassessment of stress and anxiety score by twelve weeks follow-up showed significant improvement and the symptoms subsided, He adapted to the stress environment with an adequate coping mechanism. **This case highlighted the clinical complexity and diagnostic challenges in picking up a mental illness. In our case, the diagnostic approach of PROMPT with the last ‘PT’ refers to ‘Patient is trying to tell something else’ demonstrated that; without high index of suspicion, mental health illness especially during the COVID-19 pandemic, may be overlooked for early intervention to prevent inevitable consequences