BMJ 1996;313:1210 (9 November)

Letters

Telling patients there is nothing wrong

Randomised controlled trials are needed

EDITOR,--It is still unclear from the literature whether investigative tests reassure patients with anxieties about the presence of serious disease.1 2 Ray Fitzpatrick discusses some of the possible reasons for this, including psychiatric morbidity, poor communication, and the "wild card effects" mentioned in the study by I G McDonald and colleagues.3

Other psychological processes in patients are also likely to influence outcome: early childhood experiences of illness, particularly when associated with lack of parental care, are a powerful risk factor for adult somatisation, and the accuracy of patients' medical knowledge and other cognitive errors such as catastrophic thinking4 are likely to influence the effectiveness of investigations to reassure.

The decision to investigate may also reflect a physician's obsessive fear of missing organic disease and an inability to cope with any diagnostic uncertainty, which will give patients mixed messages about their symptoms. Physicians may find it particularly . . . [Full text of this article]


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Relevant Article

Telling patients there is nothing wrong
Ray Fitzpatrick
BMJ 1996 313: 311-312. [Extract] [Full Text]

This article has been cited by other articles:

  • Sudlow, C. (2002). US GUIDELINES ON NEUROIMAGING IN PATIENTS WITH NON-ACUTE HEADACHE: A COMMENTARY. J. Neurol. Neurosurg. Psychiatry 72: ii16-18 [Full text]  
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