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| Managing chronic somatisation disorder20
- Identify psychosocial cues. The patient may not volunteer these, so
skilful interviewing is required.
- Conduct a thorough physical examination and provide unambiguous
information about findings.
- See the patient regularly for review, not in response to the
patient's psychosomatic crises. Consultations during the times of
"good health" may provide an opportunity to change attitudes that
have been reinforcing illness.
- Set the agenda -- specify what the doctor will and won't do. With some
patients it is important to be very clear that certain physical
therapies will not be offered.
- Set limits for investigation by specifying what will and will not be
ordered and why.
- Ensure appropriate use of specialist referrals, and specify why a
referral is being requested.
- Avoid spurious diagnoses and do not treat what the patient does not
have. The doctor may feel pressed to invent exotic conditions to
explain the patient's behaviour and symptoms, but this will not lead
to a cure.
- Avoid a dualistic model. Many of these patients prefer to insist that
the mind has no impact on the body. The doctor must try to show them that
mind and body are linked.
- Provide an explanatory model of symptom processes (e.g., how stress
leads to unnoticed muscular tension, which can lead to pain; how
anxiety can lead to hyperventilation, producing tingling in the
fingers).
- Decide who should manage the psychosocial problems (i.e., general
practitioner or other specialist?) because it is best for one doctor
to integrate management.
- Organise joint assessments with psychiatrist of psychologist (if
they are to be involved).
- Refuse to enter debates as to whether the condition is organic or
functional.
- Be consistent and offer care.
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