Subject(s)
Communication , Medical History Taking , Medical Records , Physician-Patient Relations , Writing , Aged , Diagnosis, Differential , Female , Humans , Referral and Consultation , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Stress, Psychological/complications , Stress, Psychological/psychology , Young AdultSubject(s)
Aging/psychology , Body Image , Emotions , Memory, Episodic , Self Concept , Aged, 80 and over , Delusions/psychology , Female , Humans , Infant , MaleSubject(s)
Attitude of Health Personnel , Cooperative Behavior , Expert Testimony/legislation & jurisprudence , General Practice/legislation & jurisprudence , Insurance, Disability/legislation & jurisprudence , Interdisciplinary Communication , Pain Measurement , Adult , Back Pain/diagnosis , Back Pain/psychology , Croatia/ethnology , Diagnosis, Differential , Eligibility Determination/legislation & jurisprudence , Emigrants and Immigrants/psychology , Humans , Male , Psychophysiologic Disorders/diagnosis , Switzerland , Work Capacity EvaluationSubject(s)
Athletic Injuries/psychology , Physician-Patient Relations , Skiing/injuries , Truth Disclosure , Aged , Female , Humans , SwitzerlandABSTRACT
OBJECTIVE: To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training. METHODS: A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness. The symptoms had begun before her final nursing- exam and exacerbated on her mother's 60th birthday two months later. The patient's mother is the sole caretaker for the patient's sister, who also attended the birthday party. The patient's sister is 19 and had been diagnosed with storage disease and is wheelchair-bound. The doctors were asked to record their observations and interpretations while reviewing the case report. RESULTS: Group A-physicians mentioned and interpreted the physician-patient relationship and the patient's body language as described in the case report more often (p = 0.002, Wilcoxon-Mann-Whitney rank sum test (RS)), mentioned physical symptoms more often (p = 0.0099, Fisher's exact test (FE)) and more often interpreted illness settings with respect to the patient's fear and guilt (Fisher's exact test, p = 0.007 and p = 0.015). A precise integrative diagnosis (life events leading to stress, the latter evoking fear and guilt, leading to symptoms of the fight-flight reaction) was suggested by 7 of group A and 4 of group C. Extensive laboratory work-up and requests for consultations were more frequently asked for by the C group (p = 0.048, RS). CONCLUSION: Residency training in biopsychosocial medicine in an Internal Medicine Department increased sensitivity to and interpretation of biological and psychosocial data many years after the training and decreased the extent of work-up and consultation costs. However it only tended to enhance psychosomatic conceptualisation with respect to anxiety/guilt/hyperventilation and conversion symptoms.
Subject(s)
Clinical Competence , Internal Medicine/education , Physician-Patient Relations , Psychophysiologic Disorders/diagnosis , Stress, Psychological/diagnosis , Adult , Female , Humans , Kinesics , Life Change Events , Male , Middle Aged , Observer Variation , Psychophysiologic Disorders/etiology , Stress, Psychological/complicationsABSTRACT
In 1977, Engel published the seminal paper, "The Need for a New Medical Model: A Challenge for Biomedicine" [Science 196 (1977) 129-136]. He featured a biopsychosocial (BPS) model based on systems theory and on the hierarchical organization of organisms. In this essay, the model is extended by the introduction of semiotics and constructivism. Semiotics provides the language which allows to describe the relationships between the individual and his environment. Constructivism explains how an organism perceives his environment. The impact of the BPS model on research, medical education, and application in the practice of medicine is discussed.
Subject(s)
Models, Theoretical , Psychophysiology , Education, Medical , Humans , Medicine in LiteratureABSTRACT
OBJECTIVES AND METHODS: Gender differences regarding 17 childhood experiences, thought to have traumatising potential (Traumatic Childhood Experiences = TCE), and pain behaviour in adulthood were assessed using a self-administered, anonymously filled-out questionnaire. Patients were consecutively accrued in the offices of practicing physicians. Three research questions were formulated: 1) Are specific TCE reported more frequently in male and female patients with the diagnosis "Pain Associated with Psychological Factors" (PP), compared to patients with "Pain, explained by Organic Processes" (OP), and "Patients with Diseases without Pain" (OD)? 2) Do PP-men and PP-women differ in reporting TCE?; 3) Are specific TCE correlated with Pain Duration, -Intensity and Number of Operations? RESULTS: 1). TCE occurred more frequently in PP-men and PP-women compared to OP- and OD-patients. 2). The PP-women reported much more TCE-items than the PP-men. 3). Duration and Intensity of adult pain associated with psychological factors correlated with certain TCE-items. CONCLUSIONS: The three research questions can be answered by "yes". In patients with pain which has been impossible to diagnose and/or has resisted conventional forms of therapy, TCE (verbal, physical and sexually abusive) have to be looked for, because they often explain adult pain. Unnecessary examinations and surgery can be avoided and therapies can be tailored for the individual patient.
Subject(s)
Child Abuse/psychology , Life Change Events , Pain/psychology , Parent-Child Relations , Stress, Psychological/epidemiology , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Sex Distribution , Sex Factors , Surveys and QuestionnairesABSTRACT
AIM: The purpose of this review was to study the relationships between negative affect states and cardiovascular disorders. PROCEDURE: The phenomenology of the negative affect states of depression, helplessness, hopelessness, vital exhaustion and grief is described. Their correlations with morbidity and mortality are analyzed. The physiological correlates of the affect states are pointed out. Finally, the reaction pattern of conservation-withdrawal according to Schmale and Engel and its ontogenesis are outlined. This is a disengaging behavior pattern as opposed to the engaging fight-flight reaction pattern of Cannon. The giving up complex, with its affects of helplessness and hopelessness, is explained. CONCLUSIONS: The giving up complex in the context of the conservation-withdrawal pattern presents a biologically and developmentally sound conceptual basis for the understanding of the relationships of the negative affect states with cardiovascular disorders. This enables the integration of the concept of vital exhaustion, which has become the most promising operationalized instrument in psychosocial cardiovascular research.
Subject(s)
Cardiovascular Diseases/psychology , Negativism , Psychology , Humans , SwitzerlandABSTRACT
BACKGROUND: The aim of this study was to determine if patient narratives and interviewer reactions are specific in groups of somatic (SF) and psychogenic fatigue (PF) patients. METHODS: The interview criteria and criteria of the interviewer reaction are tested against group classification. Over a 2-year period, 51 (22 PF and 29 SF) patients fulfilling the inclusion criteria were interviewed by two trained independent interviewers. The tape-recorded interviews were analyzed and blind rated by a set of independent physicians. State and Trait Anxiety Inventories (STAI and TRAI, respectively), Beck Depression Inventory (BDI), and Beck's hopelessness scales were completed by the patients. RESULTS: SF versus PF patients more often showed a clear versus vague qualitative description (P=.03), clear changes in levels of intensity (P=.03), and clear factors contributing to the increase (P=.02) and decrease (P=.03) of fatigue. In SF, the raters more often felt calm (P=.03), interested (P=.01), and attentive (P=.02). With PF tapes, the raters more often felt impatient (P=.03), surprised (P=.03), and helpless (P=.01). For the TRAI, the mean score of the PF group was significantly higher compared with that of the SF group (P=.004). For all items, Fisher's Exact Test was used. CONCLUSIONS: Our results confirm significant differences in patient narratives and interviewer reactions for the groups examined. The systematic use of interview criteria and analysis of the interviewer reactions may contribute to the better understanding of fatigue.