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Practice What Your Patient Is Thinking

How to talk to someone with an “untreatable” lifelong condition

BMJ 2015; 351 doi: (Published 04 November 2015) Cite this as: BMJ 2015;351:h5037

Re: How to talk to someone with an “untreatable” lifelong condition

Many chronic conditions are deeply affected by the patient’s psychological health. An example would be irritable bowel syndrome (IBS). It is seen in 10-20% of the adult population and it’s clinical features and course can be unexpected. Along with this there is no definitive cure[1]. This disease has been shown to have a marked psychosomatic component, it’s pain component being linked to depression and catastrophising [2]. For conditions like this the empathy and acknowledgement provided by the doctor is vital to ensure a more positive coping strategy in the patient, and therefore potentially a less symptomatic individual. In a study in Stockholme in 2010[1] regarding the consultation experiences of IBS sufferers, it was found that the most important features of a positive consultation were “openness” and “acknowledgement” of the change to that patient’s world. This echoes the sentiments of the article.

It can be difficult for a doctor who has never personally experienced chronic, uncurable illness to understand the mental process that these patients and their families go through. Phenomenological theory of health and illness describes ill health as a state of “unhomelikeness”[1], estranged from the way the patient used to feel in their body. In a condition with no cure this essentially manifests itself as an alienation from self and a state of loss from what the patient knew as their normal life. The study emphasised that being acknowledged as a unique individual with unique problems and a unique life experience can be a highly supportive notion to these patients.[1]

It has also been shown that in chronic pain, acceptance of the condition and the idea that the pain may not improve can help both patients' mental wellbeing and even the patients' mental control of the pain.[3] All of these things are heavily influenced by patients' encounters with clinicians, and suggest positive clinical experiences are not only essential for patient’s mental wellbeing, but also may improve their symptoms in some cases. It is important always for doctors to remember that medicine is more than just pharmacology or surgery, that simply their support can make a world of difference to their patients.

[1] Håkanson C, Sahlberg-Blom E, Ternestedt BM. Being in the patient position: experiences of health care among people with irritable bowel syndrome. Qual Health Res. 2010;20(8):1116-27. doi: 10.1177/1049732310369914.
[2] Lackner JM, Quigley BM, Blanchard EB. Depression and abdominal pain in IBS patients: the mediating role of catastrophizing. Psychosom Med. 2004;66(3):435-41.
[3] Viane I, Crombez G, Eccleston C, et al. Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain. 2003;106(1-2):65-72.

Competing interests: No competing interests

14 November 2015
Daisy EA Walters
Medical student
Apartment 27 Mercury Buildings, 15 Aytoun St, Manchester, M1 3BL