Do patients with unexplained physical symptoms pressurise GPs for somatic treatment?
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《英国医生杂志》
EDITOR—The qualitative study by Ring et al on whether patients with unexplained symptoms pressurise their doctors for treatment together with the accompanying editor's choice provoked a strong response.1 2 The main criticism levelled at both is that none of the authors is a general practitioner and therefore cannot speak with authority.
Second comes the acknowledgment that there are indeed patients who are difficult and a drain on doctors, although the term "heartsink" is met with scepticism. The idea that hospital consultants might not treat the patients in question any better is also mooted, especially as general practitioners have the edge on other doctors in consultation skills because of their training.
Some correspondents report terrible cases in which a diagnosis was missed and caused unspeakable suffering. Some predict that time and budgetary constraints are a serious obstacle now and will be even more of a hindrance in years to come. Others admit that there are both difficult patients and difficult doctors. Doctors should always be honest and humble, in case they get it wrong, and blaming patients is not the way forward as all known medical conditions were unknown at some point in the past. A number of psychologists recommend that general practitioners do not assume the roles of psychiatrists or psychologists.
Several responses have resource implications. A couple recommend getting a second opinion in doubtful cases but add at the same time that the current culture of British medicine does not favour second opinions. One correspondent recommends delaying any further discussion of unexplained symptoms until the resources are available to order all the tests that are required to make a diagnosis and put doctors' and patients' minds at rest.
All in all, unexplained symptoms seem as puzzling for doctors as they are for patients. A level headed analysis comes from Joan McClusky, a medical writer in New York: general practitioners do the best they can—and so do patients who keep coming back because treatments are not working.
Birte Twisselmann, technical editor
BMJ
Competing interests: None declared.
References
Electronic responses. Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7447/1057 (accessed 21 May 2004.)
Electronic responses. Insights into intimacy. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7447/0-g (accessed 21 May 2004).
Second comes the acknowledgment that there are indeed patients who are difficult and a drain on doctors, although the term "heartsink" is met with scepticism. The idea that hospital consultants might not treat the patients in question any better is also mooted, especially as general practitioners have the edge on other doctors in consultation skills because of their training.
Some correspondents report terrible cases in which a diagnosis was missed and caused unspeakable suffering. Some predict that time and budgetary constraints are a serious obstacle now and will be even more of a hindrance in years to come. Others admit that there are both difficult patients and difficult doctors. Doctors should always be honest and humble, in case they get it wrong, and blaming patients is not the way forward as all known medical conditions were unknown at some point in the past. A number of psychologists recommend that general practitioners do not assume the roles of psychiatrists or psychologists.
Several responses have resource implications. A couple recommend getting a second opinion in doubtful cases but add at the same time that the current culture of British medicine does not favour second opinions. One correspondent recommends delaying any further discussion of unexplained symptoms until the resources are available to order all the tests that are required to make a diagnosis and put doctors' and patients' minds at rest.
All in all, unexplained symptoms seem as puzzling for doctors as they are for patients. A level headed analysis comes from Joan McClusky, a medical writer in New York: general practitioners do the best they can—and so do patients who keep coming back because treatments are not working.
Birte Twisselmann, technical editor
BMJ
Competing interests: None declared.
References
Electronic responses. Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7447/1057 (accessed 21 May 2004.)
Electronic responses. Insights into intimacy. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7447/0-g (accessed 21 May 2004).