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Views And Reviews

Through uncharted waters

BMJ 1994; 308 doi: (Published 08 January 1994) Cite this as: BMJ 1994;308:143
  1. T Greenway

    Contemporary general practice teaching encourages us to assess our patients' emotionalresponse to illness. As a profession our response is too often to medicalise feelings. Emotions are mistaken for psychopathology; fear and apprehension labelled as anxiety; sadness as depression. We compound matters by treating pharmacologically rather than reassuring. Reassurance is undervalued. If we explore our patients' fears and concerns, clarify their beliefs about their illness, if we can listen to them and given them time to talk we can begin to give them appropriate explanations about their illness and our proposed management. More importantly we allow the development of trust. I think it is this combination of addressing both intellectual and emotional issues that lessens fear and apprehensionand is the key to effective reassurance. Being a patient recently has been salutary. WhatI understood intellectually I have now experienced emotionally.

    “He had used his skills to allow me to express my fears and reflect on the facts.”

    Having had intermittent back pain for the past 10 years I dismissed another episode, this time with mild sciatica, brought on after a bout of winter digging. After two months,however, it was no better. I saw the physiotherapist. She cut through my self denial and said that it was a disc lesion. In spite of her treatment I got no better, probably because I declined her advice to take time off - I was a professional and indispensable. I hadpatients needing terminal care, …

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