How could a doctor order diagnostic tests for nine months on a patient with abdominal pain, but not once ask her about stress? During my first visit with this patient I learned she suffered punches and slaps from her partner up to 2-3 times per week. These episodes occurred with little warning, causing her home to resemble a mine field. With the help of a social worker she moved into a new apartment and her painful physical symptoms ended within a week.
When I informed her previous doctor about this excellent outcome, the doctor wrote back: “Thank you for taking care of her. It is reassuring to know I didn’t miss anything important.” I almost couldn’t believe what I was reading. With a mixture of anger and despair I thought about the many ways the patient had suffered needlessly. In addition to the physical pain of her symptoms, there was emotional and physical pain from the domestic violence; there was discomfort, risk and expense from her diagnostic tests and finally uncertainty and self-doubt when no explanation for her illness was found.
The attitude of her physician is inexcusable. Physical symptoms caused by stress are responsible for over half of visits to primary care clinicians. It is unacceptable that the educational system for health care professionals leaves most with no formal training in what to look for when diagnostic tests are normal. Many, like the doctor above, simply conclude that these issues are not part of their job description.
Tags: Blind Spot, illness, stress
