Archive for the ‘Changing the System’ Category

How Physicians View Stress Illness (1)

Monday, April 25th, 2011

Jerome Groopman, MD is the Chair of the Department of Medicine at Harvard Medical School and an author of numerous scientific journal articles on AIDS and cancer.  His recent book, How Doctors Think, has been a best seller.


Stress Illness and Shared Responsibility (1)

Sunday, March 27th, 2011

Before I retired from practice in 2009, I developed an excellent working relationship with a Gynecologist whom I never met or spoke with.  Though we exchanged a few emails, our principal form of communication was through reading assessments of patients he referred to me.  These were usually younger women who had suffered pain in the pelvic area for months or years.  Pelvic exams, ultrasounds, CT scans and blood tests showed nothing.


Stress Illness in Richland, Washington

Friday, March 11th, 2011

After my lecture on stress illness yesterday at the beautiful and innovative Kadlec Hospital in Richland, Washington, USA, a young specialist physician came to me with a question.  (I will change a few details to preserve confidentiality).  She described a patient with pain in his back, chest and the left lower corner of the abdomen but no abnormalities on diagnostic tests.  She went on to explain several diagnoses she considered but acknowledged that none of them were a good fit for all the features of her patient’s condition.  Her initial treatment suggestions had not been helpful and she felt the patient was about to conclude that “I’m just as bad as his other two doctors.”


Oliver Wendell Holmes, Jr and Changing Medical Practice

Saturday, December 18th, 2010

Integrating the care of mind and body has never been routine in the practice of medicine.  Finding a way to bridge that divide is a daunting task.  I found unexpected encouragement today, while bringing light and air to the surface of my desk for the first time in a year or two.  Buried in the “please find a place to file this” pile, I found a page my father had typed in law school sixty years ago.  He had passed it on to me when I finished medical school.


Stress, Illness, Social Change and the PPDA (4)

Thursday, November 25th, 2010

Today is the American Thanksgiving holiday.  I am in the  snow-covered Colorado high country (2200 m) with eleven family ranging in age from 1 to 70 (and a fetus aged 15 weeks).  The cooks assure me I am not needed (for the moment), even for the unskilled labor that is my forte in the kitchen.  So I have time to conclude my notes (for now) on the PsychoPhysiologic Disorders Association (PPDA).


Stress, Illness, Social Change and the PPDA (3)

Monday, November 22nd, 2010

Getting the PsychoPhysiologic Disorders Association (PPDA) to the level described in the last post will be challenging.  The financial support needed to sustain that quality and amount of service can only develop from recognition that the PPDA offers the best opportunity for positive change.  This means personal change for individuals afflicted with PPD, improvement in the ability of mental health practitioners to manage PPD, greater understanding by medical clinicians of stress-related symptoms and change in the health care system to enable appropriate diagnosis and treatment of PPD.  For the PPDA to achieve that means involving the most experienced people in our work, provided they are committed to an evidence-based approach.


Stress, Illness, Social Change and the PPDA (2)

Tuesday, November 16th, 2010

What might the PsychoPhysiologic Disorders Association (PPDA) look like in the future?  There are so many dimensions it  is difficult to know where to begin.


Stress, Illness, Social Change and the PPDA (1)

Friday, November 12th, 2010

When you take on a problem that has defied solution for 2500 years, it seems wise to plan on many years of work.  Hippocrates described patients who closely resemble those we know to have psychophysiologic disorders (PPD, the new technical term for Stress Illness) but did not provide treatment based on accurate diagnosis.  As far as most PPD patients are concerned, we haven’t made much progress since then.  Even Sigmund Freud, who was on the right track for awhile, was regularly committing malpractice with these patients by his early 40s.


Stress Illness and Surprises

Tuesday, November 2nd, 2010

In presenting my lecture last month in four US states and two European countries, one story always got a big reaction.  A woman of about 60 years of age had unexplained chest pains (requiring narcotics) for nearly two years that were linked to finding a letter from her emotionally abusive mother.  She found the letter in the family Bible just after her mother’s funeral.  Among other things the letter had a list of “10 Reasons Why I Hate You.”  The woman’s chest pains faded rapidly after we uncovered this connection and she wrote her mother an emotional and cathartic reply.


The Collaborative Family Healthcare Association (CFHA)

Tuesday, October 26th, 2010

In March of 1993, 15 colleagues from the fields of family medicine and family therapy met to think about a better way to deliver primary care.  They concluded that integrating the expertise of biomedical and psychosocial providers with family and community as key elements in the practice model would be ideal. They called their idea the “collaborative family healthcare model”, formed the CFHA and, in July 1995, held their first national conference in Washington, D.C.  It was well attended and received glowing reviews.  Last week I spoke about Stress Illness at their 12th national conference in Louisville, KY, attended by over 350 people.