Tell the whole story

doi:10.1136/bmj.39381.514780.BE

BMJ 2007;335:900 (3 November), doi:10.1136/bmj.39381.514780.BE

Letters

Talk of psychosocial factors

Tell the whole story

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

Goldacre says he sounded like an ass when explaining the complexpathogenesis of back pain on radio, but he is unduly harsh onhimself.¹ His message is not wrong, and he is not an ass. However,the message might have been better gift wrapped.

Western medicine is based on the biomedical model. This modelis reductionist—all symptoms can be explained by underlyingpathology—and dualist—if there is no pathology,it's all in your head. This model was drilled into us at medicalschool and is the principal model for the National Health Service.Society largely accepts the model too.

But it's wrong. For up to 90% of people presenting to theirgeneral practitioner with genuine physical symptoms, the symptomsare not explained by pathology. It is also not appropriate tolabel most of these patients as anxious or depressed. I nowexplain this to patients, and tell them that the problem . . . [Full text of this article]

Charles T Vivian, consultant occupational physician

Gloucestershire Royal Hospital, Gloucester GL1 3NN

charlie.vivian@glos.nhs.uk