Get It Out of Your Head

Lots of fascinating points and observations about psychosomatic conditions here. But it also includes a passage on communication between doctors and patients that struck me hardest.

While not a psychiatrist, O’Sullivan proposes that their collapse and convulsions “happen for a reason. When words are not available our bodies sometimes speak for us—and we have to listen.”

That listening is no longer valued in today’s medicine. The patient’s “history” was once the centerpiece of his medical record, his story written in narrative form. With current electronic templates, information is fragmented into chunks designed to meet so-called quality metrics and maximize revenue from insurers. The patient’s story has been reduced to telegraphed key words that trigger prefigured algorithms, which generate pop-ups on the computer screen for further testing or generic therapies. O’Sullivan bemoans similar changes in the British medical system.

Under the time pressure of factory-like care, the physician uses a checklist rather than talking with patients in an open-ended way; in fact, some doctors often skip taking a fresh medical history and simply cut and paste the initial evaluation from the electronic record

I was with the same GP for long enough (left about two years ago) that I sensed this change in my own treatments/relationship. I felt diagnosed more and more as a set of statistics and less as an individual with personal health history.This seemed to happen almost subconsciously. One advantage that remained was that the doctor was at least a bit skeptical of how measurements were being pushed up or down so that it was becoming harder and harder to qualify as somebody in the “normal range.” It’s enough to make you suspect a plot to get everybody to take more medicine.

The passage also reminded me of my mother’s failure to cope with her increasing depression after her mid-70’s. Even though her own mother was a nurse, she grew up believing women shouldn’t complain in general and that negative mental conditions were a source of shame and should barely be mentioned to anyone and never outright discussed. So she would bullshit her GP that she was fine, fine, same as ever, happy as a clam and upbeat as a drum. Threw a shadow over our relationship for many years.

On the other had, the antidepressants she eventually did end up using erased a lot of her personality. So …?

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