Psychosocial Context (1)

The health care system has a strong bias toward viewing people as purely biological organisms.  This approach ignores two critical facts:

1. Two individuals with the same disease may have significantly different needs due to their differing psychosocial backgrounds.

2. In more than half of people who consult a physician for symptoms, their illness is due only to psychosocial factors and there is no diseased organ. (1)

All this can be summarized as a simple equation that is easy to remember:

Psycho-Social Context  +/-  Disease = Illness

The + part of +/- means that every patient with a disease has a psychosocial context (see Fact #1 above).  The part of +/- applies to the 60% of symptomatic primary care patients who have no disease (1) as described in Fact #2.

The problem is that skills needed to gain understanding of the psychosocial context are taught poorly if at all.  This has resulted in the largest blind spot in medicine.  Nearly all of the thousands of patients referred to me for medically unexplained symptoms were not diagnosed due to failure to assess their psychosocial issues.

More in the next post.

1. Kroenke, K & Mangelsdorff, AD. Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy and Outcome. Am J Med 86: 262-266, 1989.       60% of primary care patients had no diagnostic explanation for their symptoms one year after presentation.

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