How Physicians View Stress Illness (1)

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.

The vice president of the newly incorporated Psychophysiologic Disorders Association sent me the following quote from Dr Groopman:

“Doctors often dislike their hypochondriac patients; they consume inordinate amounts of time, and strain hospital resources with their interminable complaints. In the United States, it is estimated, twenty billion dollars a year is spent on patients whose psychological distress requires repeated tests and procedures. Many doctors and nurses make fun of hypochondriacs, calling them “crocks” and “turkeys.” The favored epithet among interns and residents is GOMER, which stands for Get Out of My Emergency Room. Many doctors are relieved when a hypochondriac leaves them for another physician.”

Dr. Groopman is highlighting two errors that are typical for physicians and instructive for those interested in psychophysiologic disorders (the new technical term for stress illness).

First, he points out that physicians lump together patients with medically unexplained symptoms and label them all as hypochondriacs. Much more useful is understanding that there are at least two other conditions that commonly produce illness that diagnostic tests cannot explain.  All three of these are distinct in both diagnosis and treatment.  Correctly identifying which of the three is responsible for the patient’s illness is essential to appropriate care.  More on this in the next post.

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