To continue discussion of the Kroenke & Mangelsdorff research*, let’s begin by looking at what became of all 567 symptoms (in 380 patients). For 2/3 of the symptoms, doctors did diagnostic testing or referred to a specialist. In the other 1/3, no evaluation was done beyond the initial visit. Treatment was recommended for only 55% of symptoms, and this took the form of a prescription in over ¾ of cases. There was nothing to suggest that anyone searched for hidden stresses linked to the symptoms (posts tagged with “Stress History” explain how this is done).
Did the treatments work? ¾ of symptoms had at least one follow-up visit, averaging 11 months later. In most of those the medical record included a comment on the status of the symptom. The comments showed that of those treated for disease of a body organ, 74% improved. However, of those with symptoms of unknown cause, only about ½ improved whether they were treated or not, probably because they weren’t correctly diagnosed.
In their discussion the authors point out that they might have found even more patients with unexplained symptoms if they had included longstanding (chronic) symptoms in their research. Even without those patients, 281 out of 1000 people developed new unexplained symptoms in three years. Despite the numbers, physicians had little to offer: there was no evidence that a stress history was taken, almost half the symptoms were left untreated and only about half experienced improvement.
For a condition that can readily be diagnosed and treated, this is appalling. Stress illness is the single most common cause of symptoms in primary care and yet, people are not being helped. The amount of needless suffering is unconscionable. Unfortunately, 21 years later the situation hasn’t changed. Medical professionals still are not being taught that unexplained symptoms have real causes that can be found (and successfully treated) if you know what questions to ask.
See the series of posts tagged with “Blind Spot” for some ideas on what could be done to turn this travesty around. Future posts will look at Integrated Primary Care which has great potential for meeting the needs of stress illness patients.
* Kroenke, K & Mangelsdorff, AD. Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy and Outcome. Am J Med 86: 262-266, 1989.
Tags: Blind Spot, illness, Integrated Primary Care, Kroenke, medical education, stress, Stress History
