Among physicians with a humanistic soul, perhaps no quotation is more fondly remembered than one from Dr Francis Peabody. He was born in 1881 to a prominent New England family, trained at Harvard and Massachusetts General Hospital and was the first director of the Thorndike Laboratory at Boston City Hospital. Tragically, he died of sarcoma at age 46.
Posts Tagged ‘medical education’
The medical profession has been aware that psychosocial issues can lead to physical symptoms at least since the days of Hippocrates about 2500 years ago. Yet diagnosis and treatment for the pain and other symptoms lag far behind nearly every other form of illness. In thinking about this I began to recognize several challenges to improving the quality of care for this condition.
The latest evidence of the woeful state of care for Psychophysiologic Disorders (Stress Illness) comes from my local newspaper. In a Health column, we find the following question from a reader:
In the last two posts, we reviewed a quotation from Dr Jerome Groopman that highlighted two common physician errors, the first being to lump together all patients with medically unexplained symptoms and label them hypochondriacs.
In the last post, a quotation from Dr Jerome Groopman highlighted two common physician errors, the first being to lump together all patients with medically unexplained symptoms and label them hypochondriacs.
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.
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.
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.”