“Persistent physical symptoms” preferred term? Chronic pain overlaps.
“Functional disorder” is used for various gastro and neurological problems, preferred by some adults, but needs explained!
Chronic fatigue syndrome and PANDAS are health disorders that appear to have a physical/scientific cause but disputed.
Health anxiety, malingering, or factitious illness, different from a psychological point of view.
Bleed the symptoms dry! [John Stone, Glasgow].
In a 1965 paper by Eliot Slater, more than half of patients diagnosed as having “hysteria” later turned out to have “organic” disease – but John Stone’s study of adult neurology referrals found very few who turned out to have an occult disease.
Louise Stone in Australia has done a lot of work in primary care. She identifies negative feelings and a lack of diagnostic language and frameworks as barriers to managing these patients effectively. The negative feelings (such as frustration, shame and helplessness), are shared between doctors and patients…
Managing your own feelings and frustrations, and finding ways of understanding and managing the therapeutic relationship important.
Let family feel validated for all concerns – at least in the first instance. Helps develop a therapeutic alliance.
Commit to the patient, which includes advocacy and support.
Family response to symptoms?
Explore beliefs, specific worries (eg cancer). May then allow broadening out to more general worries.
Manage uncertainty – including managing the need for a disease name! Not having a predictable outcome is hard.
Harm minimisation. Shift from diagnosis to coping with ongoing symptoms.
Good to offer a tentative preamble to difficult conversations! “This is something we as doctors have to deal with every day – signs and symptoms that are very real, with a real impact on a child/family, but where physical examination and investigations do not offer any clues to what the underlying problem might be…”
Paed psychology if issues mostly seem related to child and this is a new problem; CAMHS if new problem adding to existing child/parent issues.
Can be rewarding in the long term!
[Louise Stone, Aust Fam Physician 2013 Jul;42(7):501-2]