Managing medically unexplained illness in general practice

Provides practical management strategies that general practitioners (GPs) can use when patients present with medically unexplained symptoms. Background Patients with medically unexplained symptoms commonly present to general practice and experience significant disability. Many have a history of trauma, which complicates the therapeutic relationship between doctor and patient. Because diagnosis is an expected outcome of a medical interaction, doctors and patients can feel frustrated and lost without one. Objective This article provides practical management strategies that general practitioners (GPs) can use when patients present with medically unexplained symptoms. Discussion Three types of common presentations are discussed. Enigmatic illnesses occur when the doctor and patient believe that a bio-medical disease is likely, but a diagnosis is not forthcoming. Contested illnesses occur when a patient is committed to a diagnosis the doctor does not accept. Chaotic illnesses occur when symptoms are over-determined; there are many possible diagnoses, but none fully explain the complex web of distress the patient experiences. Common strategies for managing medically unexplained symptoms are discussed, and specific approaches to each presentation are outlined

The Language of Mental Illness

This paper surveys some philosophical issues with the language surrounding mental illness, but is especially focused on pejoratives relating to mental illness. I argue that though 'crazy' and similar mental illness-based epithets (MI-epithets) are not best understood as slurs, they do function to isolate, exclude, and marginalize members of the targeted group in ways similar to the harmfulness of slurs more generally. While they do not generally express the hate/contempt characteristic of weaponized uses of slurs, MI-epithets perpetuate epistemic injustice by portraying sufferers of mental illness as deserving minimal credibility. After outlining the ways in which these epithets can cause harm, I examine available legal and social remedies, and suggest that the best path going forward is to pursue a reclamation project rather than aiming to censure the use of MI-epithets

Washington Pension System Review

The purpose of this study is to analyze the incidence of Total Permanent Disability (TPD)pensions in Washington State's workers' compensation program. Concerns exist at both thelegislature and in the Department of Labor and Industries as there appears to have been a sharp upturn in the number of pensions awarded since late in the 1990s. This report examines the factors that may be causally related to any upsurge in such awards. Our task is to evaluate pension incidence for both the state fund and the self-insured populations, with a view towards identifying causes of the trend in both sectors, although we concentrate more on the state fund Cclaims due to data limitations

The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice.

BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous 'yes' or 'no' is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient's future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. SUMMARY: Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care

Women's experiences of increasing subjective well-being in CFS/ME through leisure-based arts and crafts activities: A qualitative study

This is the author's accepted manuscript. The final published article is available from the link below. Copyright © 2008 Informa Plc.Purpose. To understand the meanings of art-making among a group of women living with the occupational constraints and stigma of CFS/ME. The study explored their initial motives for art-making, and then examined how art-making had subsequently influenced their subjective well-being. Method. Ten women with CFS/ME were interviewed; three provided lengthy written accounts to the interview questions. Findings. Illness had resulted in devastating occupational and role loss. Participants took many years to make positive lifestyle changes. Art-making was typically discovered once participants had accepted the long-term nature of CFS/ME, accommodated to illness, and reprioritized occupations. Several factors then attracted participants specifically to art-making. It was perceived as manageable within the constraints of ill-health. Participants also tended to be familiar with craft skills; had family members interested in arts and crafts, and some desired a means to express grief and loss. Once established as a leisure activity, art-making increased subjective well-being mainly through providing increased satisfaction in daily life, positive self-image, hope, and contact with the outside world. Participants recommended provision of occupational/recreational counselling earlier in the illness trajectory. Conclusions. Creative art-making occurred as part of a broader acceptance and adjustment process to CFS/ME, and allowed some psychological escape from a circumscribed lifeworld

Diagnostic Categories in Autobiographical Accounts of Illness.

Working within frameworks drawn from the writings of Immanuel Kant, Alfred Schutz, and Kenneth Burke, this article examines the role that diagnostic categories play in autobiographical accounts of illness, with a special focus on chronic disease. Four lay diagnostic categories, each with different connections to formal medical diagnostic categories, serve as typifications to make sense of the way the lifeworld changes over the course of chronic illness. These diagnostic categories are used in conjunction with another set of typifications: lay epidemiologies, lay etiologies, lay prognostics, and lay therapeutics. Together these serve to construct and reconstruct the self at the center of the lifeworld. Embedded within the lay diagnostic categories are narratives of progression, regression, or stability, forms of typification derived from literary and storytelling genres. These narratives are developed by the self in autobiographical accounts of illness

Euthanizing people who are 'tired of life'

In Belgium and the Netherlands, a debate is developing about people who express a desire to end their lives although they do not suffer from an incurable, life-threatening disease. In 2000, a court in Haarlem in the Netherlands considered the case of 86-year-old Edward Brongersma who had expressed his wish to die to his general practitioner, Dr Philip Sutorius, claiming that death had ‘forgotten’ him. His friends and relatives were dead, and he experienced ‘a pointless and empty existence’ (Sheldon 2000). After repeated requests, Dr Sutorius euthanized his insisting patient and was then put on trial. The public prosecution recognized that Dr Sutorius fulfilled all the legal criteria but one: ‘hopeless and unbearable suffering’. Therefore, the patient’s request should have been refused. The court did not discipline Dr Sutorius, saying that the patient was obsessed with his ‘physical decline’ and ‘hopeless existence’ and therefore was suffering ‘hopelessly and unbearably’. A spokesman for the Royal Dutch Medical Association reacted to the court judgement by saying that the definition of ‘unbearable suffering’ had been stretched too far and that ‘what is new is that it goes beyond physical or psychiatric illness to include social decline’ (Cohen-Almagor 2004). The then Justice Minister Benk Korthals said that being ‘tired of life’ is not sufficient reason for euthanasia (Sheldon 2000). Since then, the debate as to whether physicians should comply with euthanasia requests of people who are ‘tired of life’ has been widened and many people in Belgium and in The Netherlands are calling for the law to be expanded in order to include similar patients (Van Wijngaarden et al. 2014)

Children's bodies: the battleground for their rights?

The UNCRC has changed profoundly ideas about adult/child relationships and there is now an acknowledgment in both law and policy that children have a right to be consulted and to participate in decisions made about their lives. This has been widely discussed and critiqued and one of the most significant battlegrounds for debate has been children’s rights to consent or refuse medical treatment and the issue of exactly who has the right to control children’s bodies. This article will compare several cases where the English and Scottish courts have made various decisions and rulings about the extent to which children do have rights to control their bodies. It will question why, twenty years after the UK ratified the UNCRC, children are still considered incompetent in matters concerning their own bodies, unless proved otherwise, while adults are automatically considered competent unless shown not to be and will analyse whether this situation is compatible with a children’s rights agenda