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 interview’
A colleague asked how I would screen for Adverse Childhood Experiences (ACEs) in primary care patients with unexplained illness, chronic pain or functional syndromes such as irritable bowel or fibromyalgia. (A blog of mine describing ACEs is here with an important web site here). Here is my answer:
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 search continues for a valid, ultra-short screening questionnaire for stresses capable of causing physical illness. Once that is in place, the next step is for primary care clinicians to learn how to further evaluate a patient with a positive screen. This should then lead to systems for follow-up care and monitoring, including the option of referral to mental health clinicians experienced with patients who have physical symptoms.
In the last post we saw four questions (PHQ – 4) that screen for anxiety and depression. These are described in the reference below (1). However, to document that screening questions achieve their intended goals and are scientifically valid, it is not enough merely to come up with what sound like reasonable questions.
One of the most frequent questions I get after my talks to medical clinicians is about rapid ways to screen for sources of stress. A validated questionnaire that revealed stress issues prior to the patient being seen would, theoretically, enable more accurate diagnosis in less time.
Bethesda, Maryland. April 1. The Center for Irreproducible Results at the National Institution of Health today announced a stunning breakthrough that is certain to benefit hundreds of millions of patients. Dr. Freddie P. Ignobel reports that she has found a blood test that can reliably confirm when physical symptoms are caused by life stresses and not by a disease of an organ or a metabolic problem.
Concluding with Part 5 of the Stress Illness brochure:
IV. Stress From A Traumatic Experience
Continuing with Part 4 of the Stress Illness brochure:
III. A Disease Called Depression