Managing patients with inexplicable health problemsBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7389.595 (Published 15 March 2003) Cite this as: BMJ 2003;326:595
- Baruch Fischhoff, professora,
- Simon Wessely, professor ([email protected])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
- Accepted 27 January 2003
The causes of many health problems remain a mystery despite the advances of modern medicine.1 When a medical explanation is slow in coming, patients often infer that events (and perhaps people) are responsible for their condition. They may then judge harshly anyone who does not take their condition and inferences seriously. Physicians, officials, and companies often bear the brunt of this anger.2 For example, in the controversies surrounding chronic fatigue syndrome, Gulf war sickness, and cancer clusters, authorities who denied sufferers' claims met with scorn and contempt.
Public unease, such as caused by the current threat of terrorism, is likely to make medical mysteries more common.3 We therefore need a disciplined public health response for dealing with inexplicable health effects. In this article, we discuss how illness beliefs arise and suggest principles for dealing with patients.
Without a medical explanation, patients are likely to attribute their illness to events
Terrorist threats are likely to increase the number of unexplained health problems
Doctors need guidance to avoid alienating such patients
Communication should be focused on patients' concerns
Relief of symptoms should be the priority
Risks should be given numerically and scientific uncertainty acknowledged
Development of illness beliefs
Any widescale medical intervention will coincide with the development of medically unexplained symptoms. The intervention may then be seen as a putative cause.4 Currently, smallpox vaccinations are an obvious target for such attributions, given the publicity surrounding them and their high level of side effects.
Patients naturally want explanations and treatments for their ill health. Professionals, on the other hand, want to …
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