I attended so many presentations at the annual APS meeting last week that I had no time left to post an entry here. I also presented my talk on diagnosing physical symptoms connected to psychosocial stresses though only 20 people attended out of several hundred at the meeting. One possible reason for that became apparent as I attended other symposia since most focused on the impact of stress on disease of body organs. For example, numerous studies were presented or referred to that measured cortisone (a stress hormone) in saliva in various situations or showed images of brain activity. There was far less about diagnosis and treatment of people whose symptoms are not explained by diagnostic tests, even though (as my readers know well) this is the largest single group of patients in all of primary care.
As a gastroenterologist I’m new to this world. I’m still exploring it looking for anyone and everyone that understands that patients with medically unexplained symptoms can be diagnosed, treated and usually relieved of much or all of their illness. Most of the clinicians and PhD researchers I have encountered so far seem to view this population as beyond hope or too difficult to approach. A distinguished psychiatrist I chatted with believed that these patients might improve a little due to the general benefits of attentive support from a clinician. However, he did not seem familiar with how often or how much they respond to specific diagnosis of underlying, usually unrecognized issues such as depression, anxiety or child abuse.
Though the research presented at APS was interesting and carefully done, I left feeling a little discouraged that most of the best minds in this field are not focused on the problems that affect the most people. So it was heartening to receive an email this morning inviting me to develop an all-day seminar to teach European family doctors about stress illness in Spain this fall. The word is getting out after all.
Tags: mental health education
