Managing patients with inexplicable health problems

doi:10.1136/bmj.326.7389.595

BMJ 2003;326:595-597 ( 15 March )

Education and debate

Managing patients with inexplicable health problems

Baruch Fischhoff, professor ^a, Simon Wessely, professor ^b.

^a Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213, USA, ^b Academic Department of Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine and Institute of Psychiatry, London SE5 8AF

Correspondence to: S Wessely s.wessely@iop.kcl.ac.uk

The first 150 words of the full text of this article appear below.

People need to rationalise their health problems, and those with medical mysteries will find some explanation. The best wayto manage such patients is unclear, but the principles describedin this article should help improve the satisfaction of both patientsand doctors

The causes of many health problems remain a mystery despite the advances of modern medicine.¹ When a medical explanationis slow in coming, patients often infer that events (and perhapspeople) are responsible for their condition. They may then judgeharshly anyone who does not take their condition and inferencesseriously. Physicians, officials, and companies often bear thebrunt of this anger.² For example, in the controversies surroundingchronic fatigue syndrome, Gulf war sickness, and cancer clusters,authorities who denied sufferers' claims met with scorn andcontempt.

Public unease, such as caused by the current threat of terrorism, is likely to make medical mysteries more common.³ Wetherefore . . . [Full text of this article]

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