Bruce Arroll is a Professor of General Practice at the University of Auckland and a GP at the Greenstone Family Clinic in Manurewa Auckland
My first clinical impression of primary care was of lots of symptom clusters that did not appear in Harrisons Textbook of Medicine. These symptoms would fluctuate and I would investigate some and often find no satisfactory answers from my investigations and referrals. I gradually learned to use time as my diagnostic test and some of these symptoms would disappear while others would stay. Many of them did not follow any anatomical or physiological pattern. I now prefer the term illness without disease1 as Medically Unexplained Symptoms (MUS) sounds like if you did just one more (or the right) scan/xray/referal/consultation you'd find the answer. There was a qualitative study on what patients liked when they had MUS. Their preference was for some sort of explanation ...continue reading →
All the problems started with Descartes, who conceptualised the mind-body separation, described as the Cartesian model, began Rona Moss-Morris in her plenary talk.
She continued by explaining that, while we ought to focus more squarely on the bio-psycho-social, Medicine has not yet fully embraced this model. In general practice, however, we cannot explain everything using the biological model alone. There is often a mismatch between clinical signs, objective tests and the health of the patient.
Clinicians have always recognised the concept of medically unexplained symptoms (MUS), particularly in primary care ...continue reading →
Rona Moss-Morris is Professor of Psychology as Applied to Medicine at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK. She is a keynote speaker at this year's SAPC conference in Oxford.
I am delighted to be presenting a keynote talk to the upcoming SAPC conference on a topic very dear to my heart. My interests in this area began as long ago as 1988 when I moved from South Africa to take up a post in a small East Coast town in New Zealand. One of the first patients referred to me, let’s call him Mr X, had a mysterious illness called Tapanui Flue. A previous high level athlete and school teacher, he was experiencing overwhelming and disabling fatigue. So there I was, new kid on the block in a strange country, faced with a condition I had never heard off and a very distressed patient. Still to this day I regret the fact that I wasn’t much help to Mr X. ...continue reading →