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Does Simple “Reassurance” Work in Patients with Medically Unexplained Physical Symptoms?

  • Javier I Escobar
  • Published: August 01, 2006
  • DOI: 10.1371/journal.pmed.0030313

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MUPs Illness and Disease

Posted by plosmedicine on 31 Mar 2009 at 00:01 GMT

Author: Bill Anderson
Position: Associate Medical Director
Institution: Southern General Hosoital Glasgow, UK
E-mail: bill.anderson@northglasgow.scot.nhs.uk
Submitted Date: November 06, 2006
Published Date: November 7, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

This is useful and could trigger a renewal of how the medical profession works. We are in transition at the present and what we have been trained for is less and less relevant. This disjunction between what we were trained for and how we practise has given rise to a generation of unhappy doctors.

The traditional "doctor" dealt with symptoms and illness for which there was no useful explanation and became expert in managing these. We have completed a century or more of science and pathology and have trained doctors to derive their interventions from an (often cursory) consideration of the patient's illness and by applying reason within this scientific framework in the unshakable belief that that gave the best and at times the only possibility of assisting the patient in a meaningful way. The practical effects of such practices were rarely if ever examined. This approach had many successes buts lots of failure and we have moved on. We now have built on the science a growing evidence base which to date principally addresses disease states (pathological processes) rather than illnesses (patients' experiences).

There is however no reason why evidence based approaches cannot be applied to the mangement of symptoms and illness as well as disease states. As we develop that evidence base the nature of clinicians can change. We will not require all "doctors" for want of a better word to be comprehensively trained in bioscience. They will more deploy skills in implementing well developed evidenced interventions and fitting them to the illness the patient is experiencing. Such "doctors" will deliver most care an pay better attention to the patient's symptoms and illness than we do today. We will of course require another different sort of "doctor" who will do the research and the sifting to develop the evidence base on which therapies will become universally dependant.

No competing interests declared.