Magazine article Clinical Psychiatry News

Physicians Encouraged to Note Patients' Stress

Magazine article Clinical Psychiatry News

Physicians Encouraged to Note Patients' Stress

Article excerpt

SAN DIEGO -- Physicians are not paying enough attention to the psychosocial distress of their patients, and they would be more effective if they did, Dr. David S. Sobel said at a meeting on alternative medicine sponsored by the American Hospital Association.

According to one study, 76% of adult patients who present to a primary care physician with the most common complaints--chest pain, fatigue, dizziness, headache, back pain, etc.--do not receive a definite diagnosis because the physician cannot identify any specific cause.

In the majority of those cases, it makes sense to consider stress or subsyndromal depressive symptoms as a part of the cause because stress intensifies discomfort and people who are not stressed tend to deal with minor aches and pains themselves and not seek medical attention, said Dr. Sobel, director of patient education and health promotion at Kaiser Permanente Northern California.

"The more unexplained symptoms that a patient has, the more you should at least consider the possibility of anxiety and especially a mood disorder like depression," he said.

Medication is not what these patients need, however, Dr. Sobel said. Nor should they be referred to a mental health care professional. Most patients who come in with stress-related, somatic complaints will not take such a referral, and would not get the care they need anyway.

Dr. Sobel outlined his own approach to managing these patients:

* Don't dispute the reality of the patient's suffering. "It's not really all in their heads, because even with somatization, there is a physiology of stress and suffering," he said.

* Investigate any potential serious conditions. Although one must be careful to investigate any red flags of serious conditions and establish a medical diagnosis for illnesses where appropriate, one should order tests and give out medications judiciously. The medical system is set up to reward somatic symptoms, and to stigmatize somatization, Dr. Sobel said. Doctors do not want to directly accuse the patient of somatization, but neither do they want to play into this system of rewards and there-by reinforce the patient's suffering.

* Follow up. Schedule a regular follow-up visit--rather than letting them return when they feel the need--and gradually introduce them to the concept of mind-body medicine, and the fact that there are behaviors and practices that can help them feel better, he recommended. …

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