Question for the Physicians

[PaloAltoCougar]

And happily, this isn't the usual plea for a diagnosis, recommendation or painkiller prescription.

I'm prepping a Seminary lesson for Tuesday morning in which I'm going to hold forth on psychosomatic ailments (I did a paper on this 35 years ago in college so I'm clearly an expert) and the psychological/spiritual elements of certain ailments. I've read the following comment from Boyd K. Packer from the '70s, and I'm wondering if you agree with what his doctor friend told him:

I recently asked a doctor of family medicine how much of his time ws devoted purely to correcting physical disorders. He has a large practice, and after thoughtfully considering, he answered, "Not more than 20 percent. The rest of the time I seem to be working on problems that very much affect the physical well-being of my patients but do not originate in the body. These physical disorders are merely symptoms of some other kind of trouble."

The 20 percent figure seems rather low, but I don't doubt that stress and other psychological elements can play a big role. Recognizing the dangers of oversimplifying here, I'm curious if you would guesstimate how often, with your patients, there are problems at work that are more than simply physical. And it probably varies from one practice area to another. If ERCougar is treating a gunshot wound or other accident victim, I'm guessing the etiology is rarely mental.

TIA

[CardiacCoug]

This is a really interesting topic. Psychiatric factors play a huge role in a lot of medical problems.

Chronic low back pain and other types of orthopedic issues and pain syndromes are highly psychological in nature in many cases.

Psychiatric problems significantly interfere with treatment of heart disease, in my experience. A lot of people with heart disease aren't able to take medications because of perceived side effects that are largely psychological in nature. For example, after it is suggested to patients that "statin" cholesterol medications may cause muscle pain, a significant percentage of patients experience muscle pain and stop the medications. Nobody knows how many of these side effects are "real" or "imagined" but I expect that a significant percentage are primarily psychological in nature. It's unfortunate because then patients are denied the benefits of these medications.

A lot of patients become obsessed with normal twinges of chest pain after having a heart attack. They need a lot of reassurance and follow-up testing to be convinced that everything is OK. Other patients have severe stress and anxiety and aren't able to sleep well for weeks after having a cardiac procedure or surgery -- kind of like post-traumatic stress disorder.

Overeating/obesity, which is really the root of a huge amount of disease in this country (everything from heart disease to cancer to orthopedic issues) is clearly a psychologically-influenced condition. Also, patients with anxiety/depression can almost never stop smoking and frequently develop other substance abuse/dependency habits. So in that sense, you could easily define > 80% of medical conditions as having a psychological basis at their root.

I would think it is probably a fair assessment to say that more obvious psychiatric issues arise in at least 40% of patients I see.

[Jarid in Cedar]

And happily, this isn't the usual plea for a diagnosis, recommendation or painkiller prescription.

I'm prepping a Seminary lesson for Tuesday morning in which I'm going to hold forth on psychosomatic ailments (I did a paper on this 35 years ago in college so I'm clearly an expert) and the psychological/spiritual elements of certain ailments. I've read the following comment from Boyd K. Packer from the '70s, and I'm wondering if you agree with what his doctor friend told him:

I recently asked a doctor of family medicine how much of his time ws devoted purely to correcting physical disorders. He has a large practice, and after thoughtfully considering, he answered, "Not more than 20 percent. The rest of the time I seem to be working on problems that very much affect the physical well-being of my patients but do not originate in the body. These physical disorders are merely symptoms of some other kind of trouble."

The 20 percent figure seems rather low, but I don't doubt that stress and other psychological elements can play a big role. Recognizing the dangers of oversimplifying here, I'm curious if you would guesstimate how often, with your patients, there are problems at work that are more than simply physical. And it probably varies from one practice area to another. If ERCougar is treating a gunshot wound or other accident victim, I'm guessing the etiology is rarely mental.

TIA

I wouldn't say that 80% of the etiologies are psychological, but I would agree that 80% of the patients are not doing as well with their medical problem because of how their psychological situation interacts with it. Cardiac's comments about people not taking medication because of perceived side effects is spot on.

[wuapinmon]

I wouldn't say that 80% of the etiologies are psychological, but I would agree that 80% of the patients are not doing as well with their medical problem because of how their psychological situation interacts with it. Cardiac's comments about people not taking medication because of perceived side effects is spot on.

If my mom reads about the side effects of any medicine she's taking, she WILL have them......sometimes all of them.

She will just stop taking medicine if she doesn't like how it makes her feel.

[San Juan Sun]

I'd say 50% at least, for sure. Especially Trauma patients.

[BigPiney]

If my mom reads about the side effects of any medicine she's taking, she WILL have them......sometimes all of them.

Me too. Those 4 hour long erections are just too much.

[hostile]

I'd say 50% at least, for sure. Especially Trauma patients.

[San Juan Sun]

I've admitted 5 cases of frostbite in the last 24 hours. 3 of 5 have a psych history, so I'm at 60% so far.

[creekster]

I've admitted 5 cases of frostbite in the last 24 hours. 3 of 5 have a psych history, so I'm at 60% so far.

I blame it on the norwegians. some sort of ray gun experiment.

[San Juan Sun]

I blame it on the norwegians. some sort of ray gun experiment.

Norwege sucks.

[PaloAltoCougar]

Thanks muchly to Cardiac and JIC for their contributions here, as I quoted portions of them to the class this morning, which went very well. "So you're saying we should see a bishop instead of an internist?", asked one student kiddingly (oh please, let it be kiddingly). Obviously not, but the elimination of stress, fear, anxiety or other internal turmoil is very important to good physical health. And if one is in spiritual turmoil, and you have a good relationship with your bishop, it might help. Plus there's no co-pay.

[Jarid in Cedar]

Thanks muchly to Cardiac and JIC for their contributions here, as I quoted portions of them to the class this morning, which went very well. "So you're saying we should see a bishop instead of an internist?", asked one student kiddingly (oh please, let it be kiddingly). Obviously not, but the elimination of stress, fear, anxiety or other internal turmoil is very important to good physical health. And if one is in spiritual turmoil, and you have a good relationship with your bishop, it might help. Plus there's no co-pay.

Glad it went well PAC. As always, it is nice to be useful