Is it helpful to talk with clients about the psychological aspects of their pain? — 2 Comments

  1. This is brilliant and validates what I’ve been trying to do for a long while.

    One area that I struggle with is that as a GP I am the gatekeeper to investigations and specialist opinions and conflict arises where I think there have been enough but the patients disagrees. One problem is that narratives about crap GPs and delayed diagnoses and diagnostic overshadowing abound, but counter narratives a about patients who have spent years being tested and harmed by invasive procedures and drugs are far fewer. After 25 years of practice I’ve seen plenty of delayed diagnoses but vastly more people harmed by extensive testing and treating.

    I’m certain that you’re right that kindness and a positive therapeutic relationship is key, and I have patients who I’ve known for over a decade who have taught me this. But it’s the ones who demand an explanation, but only a biological one, that cause me the most pain.

  2. Thanks for this, I’m a GP and I completely agree with your conclusion and especially like the idea that often it’s better to be kind than to be right. After a few months of trying to ‘explain-pain’ I’ve stopped in favour of trying to understand patient’s experiences and interpretations.
    In short I agree with everything you say.
    My problem relates to my role as diagnostician and gatekeeper to investigations and specialist referrals. It’s legitimate for patients to ask me for tests and referrals, so in this respect my experience as a professional is different from that of a psychotherapist. The abundance of narratives (yours among them) in which the GP is responsible for a delayed diagnosis, diagnostic over-shaddowing and failing to listen/ investigate / refer adds to a perception that symptoms must have a biological cause and a medical treatment and that the GPs job is figure this out. After 25 years of clinical practice which includes auditing every cancer diagnosis, the numbers of patients who have been exhaustively tested and harmed by excessive interventions vastly outnumbers those whose biomedical diagnoses have been delayed. These narratives are rarely shared because they’re messy, shameful and often reveal trauma, they don’t have a split between the patient-victim and the incompetent doctor, and they don’t conclude with a diagnosis that explains the pain and solves the mystery. Most of my patients which chronic pain (about 10% of my total caseload) I have wonderful relationships with, largely due to decades of continuity. But there are a few who’s insistence on continued investigations traps us both in chaos and insufferable pain. Unlike our psychotherapists (who assess them and say that they’re not ready) we cannot discharge our patients, so we have to stick with them through the tears and anguish and complaints

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