Psychosocial Context (2)

Continuing from the last post,  recall that in my practice a large majority of over 7000 patients with medically unexplained symptoms were referred due to failure to grasp the their psychosocial issues.

The good news is that these skills can be taught successfully to physicians, dentists, physician assistants, nurse practitioners, social workers, nurses and mental health practitioners and enable them to look at patients as people, not as purely biological organisms (1).  This has tangible, practical benefit for diagnosis, treatment and ethical decision-making (2,3,4,5).  There is no greater single need in the education of health care professionals and the references below do an excellent job documenting why.

1. Narrative Medicine. Rita Charon, MD.  Oxford University Press, 2006.  Applies the techniques of literary analysis to patient’s narratives of their illness.  This not only enhances the practitioner’s empathy skills but clarifies both diagnosis and treatment.

2.  Caring For Patients.  Alan Barbour, MD.  Stanford University Press, 1995.        Comprehensive review of the diagnostic and therapeutic benefits of going beyond a purely biological approach to illness and evaluating the patient as a whole person.  The author directed the Stanford University General Medicine Clinic.  Documented with over 1000 references.

3.  The Lived Experience of Violation. How Abused Children Become Unhealthy Adults. Anna Luise Kirkengen, MD,  PhD.  Zeta Books, 2010.        Explains how functional illness in adults often is caused by abuse in childhood using detailed, vivid case histories supported by over 400 references.  The author’s PhD is on the health impact of child abuse.  She has practiced primary care in Oslo, Norway since 1972.

4. From Detached Concern To Empathy. Humanizing Medical Practice. Jodi Halpern, MD, PhD.  Oxford University Press, 2001.        Detailed, carefully reasoned review of the benefits of empathic skill for clinical practice.  The author is a psychiatrist, her PhD is in Ethics and she teaches at UC Berkeley.  The book received a strongly positive review by Eric Cassell in NEJM.

5. They Can’t Find Anything Wrong! David D. Clarke, MD.  Sentient Publications, 2007.        A self-help book for patients with medically unexplained symptoms.  Uses four dozen case histories to give the reader insight into hidden psychosocial issues.  Endorsed by a past president of the American Psychosomatic Society (Drossman D) and by Dr Halpern (4).

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