Friday, April 18, 2014

My tips on how to approach an "atypical and vague" presenting complaint in General Practice

Have you ever seen a patient presenting with a set of multiple vague symptoms and "it just doesn't make sense".  Furthermore, after multiple referrals and multiple investigations, there are still more questions than answers?

Now, I would like to share with you my simple "health coaching" approach to help manage these types of presentations.

I usually say to my patient the following...

"How I would describe your set of symptoms is that it is an atypical problem.  It is quite confusing and I am not certain as to what the problem is exactly at this point.  With these sort of problems, I often think of 3 possible explanations.

  1. It is a typical problem and the Doctors who you have seen including myself, have not got our thinking hat on.
  2. It is a rare problem and it will take a longer time to work it out.
  3. There is a underlying emotional content and hence, making it a bit confusing.
What do you think it is?"

The patient's answer will help you explore whether there is a psychosomatic component to the presentation without a lot of defensiveness.

Note:  It is often dangerous to say that something is stress related without thoroughly excluding physical causes and at the same time, if psychosocial factors are not explored, patients may end up seeing multiple Doctors and exposing to multiple investigations unnecessarily.  Balance is the key here.

Would love to receive your comments and input on this subject matter.

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