|
Article Excerpt
The objective of this study was to assess the effect of a biopsychosocial intervention on patients' feelings of well-being, perceptions of health and health indicators before and after treatment in a clinic for primary care frequent attenders.
One hundred patients referred to a community-based clinic were assessed using the WONCA-COOP charts and MOS-SF36 questionnaires before and after treatment with an intervention consisting of a narrative interview, short-term cognitive-behavioral therapy, stress reduction techniques and medication.
Sixty-three out of 100 patients who completed the COOP charts at intake completed them again at follow-up and 35 patients out of 40 who completed the MOS-SF36 at intake completed them at follow-up. Statistically significant improvement was noted in five out of six categories on the COOP charts ("physical fitness" "emotions", "social function" "daily activity" and "general health status") and in four out of eight categories of the MOS ("emotional health", "physical health" "social functioning" and "pain").
We concluded that in this uncontrolled study, a biopsychosocial intervention produced a positive effect on function and self-perception of health in a group of frequent attenders from primary care.
Keywords: biopsychosocial, health perception, health indicators, frequent attenders, primary care
**********
Frequent clinic attenders present a well-known challenge to primary care physicians. They may complain of numerous nonspecific symptoms in many systems (such as fatigue, headache, and dizziness) or one recurring complaint in one system over a long period of time (such as abdominal, joint, or chest pain) (Maoz, Antonovsky, Ziv, Avrahamand, & Durts, 1995). Many symptoms remain unexplained by a specific diagnosis (Reid, Wessely, Crayford, & Hotopf, 2002). Physicians may perform various tests or conduct investigations to reach a diagnosis, to reassure the patient or to improve their relationship with patients (Kassirer, 1988). However, as testing of nonspecific symptoms increases, a "diagnostic dance" ensues that is not only unnecessary but that may also increase uncertainty and anxiety in the patient that serious undiagnosed disease exists. Investigations may also damage the doctor-patient relationship (Matalon, 1996). Patient continue to suffer from symptoms, fear serious yet undiagnosed illness and may be disappointed in the physician who has failed to uncover the source of their problems.
The physician may also fear serious disease that perhaps he has missed and may at times fear litigation (Kassirer, 1998; Matalon, 1996). These fears and feelings of helplessness when faced with recurring symptoms and insoluble problems may result in anger toward the patient. Physicians may use disparaging terms such as "crocks" or "somatizers" (Maoz et al., 1995). The term "somatizer" is used in a negative sense even though somatization is a recognized diagnosis with clear criteria for diagnosis and means of treatment (Servan-Schreiber, Kolb, & Tabas, 2000). Both the ICD-10 (World Health Organization, 2003) and DSM-4 (Kaplan & Sadock, 2000) recognize and define somatoform disorders.
Although physicians may suspect a role for emotional distress as a cause of symptoms, patients reject this assumption and reject referrals to mental health care. Thus, the "diagnostic dance" continues, costs rise, suffering persists, and the doctor patient relationship deteriorates (Matalon, 1996; Reid et al., 2002).
Mayou, Bass, and Sharpe have described the ideal intervention in this situation as a multidisciplinary one in which the patient can receive a comprehensive assessment. Investigations are carried out around the presenting symptom and its meaning to the life of the patient and an attempt to understand the connections between mind, body, and the family (Sharpe, Bass, & Mayou, 1995).
Based on these recommendations, to help patients who are frequent attenders, in a comprehensive medical environment and to improve the eroded doctor-patient relationship, a multidisciplinary clinic was opened in Petach Tikvah in 1997 by Clalit Health Services. This study follows two earlier publication of our team, which examined the economic effects of the special clinic (Matalon, Nachmani, Rabin, Maoz, & Hart,...
|
