As has been both one of the great joys and greatest challenge of my professional life over the last 30-something years to be involved in the diagnosis and treatment of patients with medically unexplained illness.
Below I have written a number of sections which cover my clinical approach medically unexplained symptoms or mystery illnesses.
The most important thing is that the patient must try to leave behind the yes/no, black/white, is it in the box/is it out of the box kind of thinking which disease based medicine is both blessed with and cursed with.
Standard medicine teaches doctors how to make a diagnosis and is very useful in acute care. The standard medical model is woefully inadequate in patients who have chronic (ongoing) symptoms. Sadly, also in standard medicine when a patient has symptoms which are severe but which are not ‘in the disease book’ they may be labelled as suffering from somatic (bodily) symptoms which are coming from a psychological (stress or anxiety or emotional trauma) cause.
Each patient is different and I want to provide you with something that is readable and informative without being over turgid so I can’t really go into all the details or you would just find yourself completely bored to tears.
I have tried to look at some of the causes of persistent unexplained symptoms which I encounter in my practice and which are generally proven amenable to treatment over the years.
One word of advice regarding the medical system in Ireland is: it is impossible for general practitioners to be a master or a mistress of the detailed treatment of every kind of medical condition. The most important skill in general practice is to be able to diagnose patients and make a competent initial assessment and prescribe treatment. The greatest challenge for your GP is to be sure to pick up serious or life-threatening illness. Unfortunately it would add years to medical school if doctors were truly to be taught detailed skills for dealing with unexplained illness. For most patients their GP is a great support, for many also a good family friend. I would always encourage patients to not allow the difficulties and challenges of dealing with an unexplained illness to blind them to the importance of maintaining a good relationship with their family doctor.
If you have potentially serious or worrisome symptoms please be certain to get checked out by your family doctor and/or consultant before coming to see a doctor such as myself who specialises in the care of unexplained illness.
- The first patient consultation is about organising all of the patient’s history in a meaningful way – if this is done then it becomes possible to ‘see the wood for the trees’. This is important before any blood tests or laboratory investigations are undertaken
- In medicine nothing replaces a comprehensive and concise medical history
- Past medical history needs to be organised in a timeline form
- To make a one hour consultation work well the skeleton information of the history needs to be provided beforehand
- Patient and doctor must give up the idea that there is one singular cause for the patient’s symptoms which I treated aggressively will provide a good outcome.
- Aggressive treatment merely tends to cause side effects
- The challenge of the consultation process is to build up a probability model which can then be tested using laboratory investigations