After my lecture on stress illness yesterday at the beautiful and innovative Kadlec Hospital in Richland, Washington, USA, a young specialist physician came to me with a question. (I will change a few details to preserve confidentiality). She described a patient with pain in his back, chest and the left lower corner of the abdomen but no abnormalities on diagnostic tests. She went on to explain several diagnoses she considered but acknowledged that none of them were a good fit for all the features of her patient’s condition. Her initial treatment suggestions had not been helpful and she felt the patient was about to conclude that “I’m just as bad as his other two doctors.”
This young physician was doing just what I did when I was still in training. She had no familiarity with stress illness and was trying desperately to find a biological disease to explain a group of symptoms that just would not fit anything she had been taught. When your only tool is a hammer, you try to solve every problem with nails.
But now she had heard my lecture. After describing the patient, she said “Do you think he could have stress illness?” I responded that I thought it was likely in this case and gave her several ideas to consider for their next encounter. She looked encouraged as we shook hands.
As I think about the young physician and her patient I multiply their mutual frustration by the one million similar encounters that occur in the United States every business day. My colleagues in this field, that we are now calling Psychophysiologic Disorders, have much to do as we plan our next teaching conference for 2012. But at least now some patients in Richland will hear some new ideas when they next visit their doctor.
Tags: medical education
