Continuing our review of the Smith and Dwamena paper (1), they describe a spectrum of severity for patients with medically unexplained symptoms (MUS). The few patients who fully meet criteria for Somatoform Disorder (2) are severely ill. The rest range from mild to not quite as severe as those with Somatoform Disorder. The group with mild MUS is the largest. Their symptoms tend to be of short duration, resolve on their own, usually don’t require much medical care and aren’t associated with significant mental health issues. They can be managed with a Stress History (see earlier posts with this tag), observation over time and a minimum of diagnostic tests.
Archive for the ‘Stress Illness Causes’ Category
Smith and Dwamena (2)
Friday, January 22nd, 2010Smith and Dwamena (1)
Thursday, January 21st, 2010We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot). Smith and Dwamena (1) agree. They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care. (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)
Empathy and the Mind-Body Problem (4)
Thursday, January 14th, 2010Continuing the story of Carla’s uncontrolled vomiting, at that time I had much to learn about stress illness. Weeks were needed to see how the pieces fit together because, as is usually the case, Carla herself did not comprehend and could not explain what was happening. The first clue was that her illness began when she was a teenage unwed mother who gave up her son for adoption. Second, when Carla was a child, her mother lived just 20 miles away but completely ignored her, causing Carla to feel unworthy and to assume guilt for many life events. Third, she had a strong belief in a God that played a direct, active role in her daily life.
Empathy and the Mind-Body Problem (3)
Wednesday, January 13th, 2010How does empathy help me in understanding a patient’s stress illness? The diagnostic process in stress illness is like putting together a jigsaw puzzle when you: (more…)
Empathy and the Mind-Body Problem (2)
Tuesday, January 12th, 2010Empathic skill is unusual in the world of medical clinicians trained in physiologic diagnosis. Part of the reason for this is that admission to school depends heavily on achievement in chemistry and biology where empathy is of little importance. Professional training continues the emphasis on science that can readily be quantified. Also consistent with the objectivity of numerically oriented science is the tradition of maintaining a demeanor of detached concern toward patients. As my friend Jodi Halpern, MD has written: “The ideal of detached concern is justified by the argument that only an unemotional physician is free to discern and meet patients’ emotional needs without imposing his own.” (1, p 25)
Empathy and the Mind-Body Problem (1)
Monday, January 11th, 2010The N-body problem is one of the most famous in classical physics, first posed by Isaac Newton in his most important book Principia Mathematica (1687). The problem is to describe the motion of bodies in space once their velocities, masses and initial positions are known. Two hundred years later a work describing the relatively simple case of three bodies (sun, earth and moon) ran to 1800 pages. The N-body problem refers to any number of objects and gets even more complex if velocities approach the speed of light. Approximate solutions were developed in the 20th Century.
Stress Illness Brochure (5)
Friday, December 18th, 2009Concluding with Part 5 of the Stress Illness brochure:
IV. Stress From A Traumatic Experience
Stress Illness Brochure (4)
Thursday, December 17th, 2009Stress Illness Brochure (3)
Wednesday, December 16th, 2009Stress Illness Brochure (2)
Wednesday, December 16th, 2009Continuing with Part 2 of the Stress Illness brochure:
How Can You Find Out If Stress is Causing Your Illness?
