Posts Tagged ‘medical education’

Stress and Blurred Vision

Thursday, March 25th, 2010

For years I would teach medical residents about stress illness by telling the true story of a 16 year old girl who came to clinic with intermittent blurred vision (the full story is in my book).  I would ask them to pretend she was in the room and to try to diagnose the cause.  They would ask questions about her symptoms and “order” tests and I would give them the results.  Very few even got close to the answer though a few, to their credit, were able to look beyond physiology alone and figure out that her vision blurred when she was crying.  The crying was from severe depression brought on by regular physical abuse by her father.


Assessing Medical Research (3)

Friday, March 5th, 2010

Published medical research can be designed in a variety of ways but the greatest credence is given to placebo-controlled randomized trials (PCRT).  Ideally, and in simplest form, this design has the following characteristics: (more…)

Assessing Medical Research (2)

Thursday, March 4th, 2010

How can a person without formal medical training assess health-related information presented by the news media?  We can start with wisdom from over 400 years ago:


Assessing Medical Research (1)

Wednesday, March 3rd, 2010

In a perfect world, every claim for a new health care treatment that reached you via the news media would be accurate and clear.  Unfortunately, the reality is that even experienced clinicians reading the evidence in medical journals need to consider carefully the meaning of the research before they use it to change how they manage their patients.  There are many ways for errors in collection, analysis and interpretation of medical research data to creep into even the best published studies.  The subject is so complex that one well-reviewed book on how to assess medical research (1) runs to over 300 pages.


5. Medically Unexplained Symptoms in DSM-5

Monday, March 1st, 2010

In the last post, I proposed a revision of the Somatoform Disorders section for the next edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association.  The DSM-5 group has proposed changing the name from Somatoform Disorders to Somatic Symptom Disorders (SSD) but this term neglects the central role of psychological or cognitive factors.  It will also cause confusion with the DSM-5 group’s other new proposal, the term Complex Somatic Symptom Disorder (CSSD).  The term CSSD suggests that it is simply a complex form of SSD but that is not at all how the DSM-5 group has defined it.  This is why I suggest replacing Somatoform Disorders with Psychosomatic Disorders, not as a diagnostic term (patients consider it stigmatizing) but as a name for this category that is well understood by mental health practitioners, medical clinicians and the public.


4. Medically Unexplained Symptoms in DSM-5

Friday, February 26th, 2010

Changes to the Somatoform Disorders section of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association potentially will have greater practical impact than revisions of any other section.  This will be the case if the tens of millions of  patients (in the U.S. alone) with physical symptoms connected to psychosocial stresses are given an appropriate diagnostic term.  To that end, I offer the following ideas to revise the Somatoform Disorders section in the next edition, the DSM-5.


2. Medically Unexplained Symptoms in DSM-5

Wednesday, February 24th, 2010

Can we repair the gaping hole in how we classify patients with medically unexplained symptoms (MUS)?  Changes are proposed for the fifth revision of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (the DSM-5, due out in May, 2013).  Unfortunately, the proposals don’t solve the problems.  To see for yourself, you can review and comment here until April 20, 2010.  To comment, you first need to register so you can log in with a password.  Then you need to go to the Somatoform Disorders and scroll down to find the comment window.


1. Medically Unexplained Symptoms in DSM-5

Monday, February 22nd, 2010

The Bible of mental health diagnosis has a glaring omission (1).  The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, used worldwide as a reference for classifying and defining mental health disorders, was first published in 1952, listing 106 disorders in 130 pages.  The last major revision was released in 1994 (297 disorders, 886 pages), followed by a “text revision” in 2000 (365 disorders, 943 pages).  None of these volumes has a diagnostic term appropriate for more than a tiny fraction of Stress Illness patients.  (Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.)


3. Medically Unexplained Symptoms in DSM-5

Sunday, February 21st, 2010

The next change proposed for the fifth revision of the Diagnostic and Statistical Manual of the American Psychiatric Association (the DSM-5) is the term Complex Somatic Symptom Disorder (CSSD).  This is intended to include such disparate conditions as Somatization Disorder, Undifferentiated Somatoform Disorder, Hypochondriasis, Pain Disorder Associated With Both Psychological Factors and a General Medical Condition, and Pain Disorder Associated With Psychological Factors.


Letter to New Medical Students (5)

Friday, January 29th, 2010

We have scheduled several “Personal Mental Health Weekends” during the academic year.  These are two or three day weekends just after an exam and just before the start of a new class when you should have a minimum of studying to do.  We encourage you to use this time to re-connect with as much of your non-medical life as possible. If you lose your humanity during medical training you may become a master of medical technique but you will not reach your potential as a physician.