Stress Illness and Shared Responsibility (2)

As described in the last post, in the future we can teach physicians who practice diagnostic medicine to be aware of Stress Illness and to ask a few key questions.  (See the screening questionnaire on the Overview page of this site for examples).  When they uncover significant stress, they can offer the patient referral for a Stress Check-Up, where a more detailed evaluation for stress is done by a mental health professional.

The term Stress Check-Up is far less worrying, frightening or insulting than the usual “psychiatric evaluation” or “mental health exam.”  Most patients with physical symptoms who are referred to mental health clinicians (MHC) fail to keep their appointments.  I believe this will change if the Stress Check-Up term is used by all concerned.

We also need to teach MHCs how to learn the chronology of their client’s physical symptoms.  This is essential to finding the links between stresses and symptoms but few MHCs have had any formal training for this.  Fortunately, it is not difficult to learn.  I was taught this technique during the first week of medical school when I had no more professional experience than I did as a college student.  Once this skill is acquired, MHCs can then use their other expertise to provide enormous benefit to clients with Stress Illness.

In summary, we are not far from a good solution for the millions of patients who currently fall into a blind spot in the health care system.  We inform medical clinicians that Stress Illness (aka Psychophysiologic Disorder) exists and teach them a few questions that screen for hidden issues.  If these are found, they refer to a MHC for a Stress Check-Up.  The MHC obtains a detailed chronology of the physical symptoms, then follows with their usual evaluation for psychosocial problems, looking for links between the two.  The stresses are then treated and if the physical illness improves significantly then the diagnosis is confirmed.

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