Dec 14, 2009

Of Course, It's All In Your Head!

A patient asks me:

"Doc, are you saying this is all in my head?"
The assumption behind the question: things in the mind are not real. Doctors also display this unfounded assumption. We just obscure our prejudices by using medical jargon like "supratentorial." (First reader to define Supratentorial and use it in a sentence wins Doctor D's prize of the week!)

Every illness you ever had was "all in your head." Seriously, where else could it have been? You have never felt a symptom, whether it was a broken ankle or a broken heart, that wasn't felt in your mind. Your mind is your consciousness. Every pain, cramp, anxiety, or ache is felt exclusively in the mind. Your mind is not a part of your body. Your body—as you know itis a part of your mind.

Doctor D, has had a couple brain-dead (literally not figuratively) patients. Trust me, they never complained of anything! They never had any symptoms. They never felt bad. And their bodies didn't survive long without minds.

Many doctors hold to this absurd theory that your body is a separate entity from your mind and physicians should focus solely on the body. But the human mind keeps getting in the way and annoying these stupid doctors. Of course it does! The mind and body are completely interwoven and inseparable.

This crazy idea that the mind shouldn't interfere with the body has spread from stupid doctors and now created a stupid culture. It is tricky to actually figure out what is going on with a person because everybody now denies their mind has anything to do with their symptoms. Lots of patients refuse to answer when Doctor D asks about their feelings about their symptoms or illness. I can understand why. They're worried that Doctor D thinks they are nuts. Having a mind doesn't make you crazy, it's loosing your mind that is crazy!

So Doctor D has some ideas for how MDs and patients can overcome our anti-mind biases and improve doctor-patient relationships:
  • First, doctors and patients both need to acknowledge that all symptoms are real. If you feel it in your mind then it is real—period. We don't say that happiness is "imaginary" because it is a mental state. We shouldn't say that any discomfort is imaginary. Fibromyalgia and panic attacks are just as real as pneumonia and broken bones.
  • Second, doctors and patients both need to acknowledge that the mind is real and it matters. I know this sound obvious, but some doctors still think only Psychiatrists should pay any attention to patients' minds. No matter what the disease, ignoring the person to focus solely on the body will lead to disaster after disaster in medicine. Patients also need to be willing to discuss their mental attitudes and recognize that the mind plays a role in illness and healing.
  • Finally, we need to understand that different symptoms need different treatments. Not every symptom needs a big work-up or a strong medicine. It is my job to help people distinguish dangerous symptoms from ones that are not. Shortness of breath that starts when your girlfriend breaks up with you merits a different work-up than shortness of breath with unilateral leg swelling and a low pulse ox. Both are real problems, but not the same problem. Understanding your mental and emotional experience of your symptoms helps me better diagnose you and avoid giving you treatments or work-ups that could cause you harm. In order to successfully negotiate these interactions a patient must trust that the doctor has taken the first and second step and isn't assuming they are crazy.

What do you think? Does it bother you when your doctor asks about your mental state when you report physical symptoms? Or does your doctor seem to be biased against the mind and imply you are crazy if you bring up your feelings? Do you think that these 3 steps can improve doctor-patient communication? Doctor D would love to hear your thoughts!


WarmSocks said...

There's a website that has mugs and t-shirts with supratentorial defined. :)


Wow and awesome post indeed. Well said, a holistic approach which should be recognised.Look how stress can trigger major medical conditions such as heart attacks and severe asthma.....

Helen said...

I value it a great deal when a doctor with whom I've built up a relationship asks about my feelings. Sometimes, stress really has been part of the answer, and at those times I've been really grateful when a perceptive doctor has asked how things are going in the rest of my life.

Doctor D said...

Congratulations WarmSocks! You win! I was going to make the prize Doctor D's eternal love and respect, but since you already earned that long ago and those mugs seem so cool you shall win a "supratentorial" mug! Just email me your address and it is yours!

Anonymous said...

I've never had a doctor ask me about my mental state regarding an illness, not even my rheumatologist. Unlike some other people who've been diagnosed with RA, I've never had a doctor tell me my pain was "all in my head," either. So I've been lucky.

That said, I would appreciate it if my PCP or rheumatologist asked me about my mental state, particularly if they asked out of real concern. I wish all doctors would adopt your ideas about this, Dr. D. We'd all be better off.

WarmSocks said...

Thought you might like the mug site :-) Thank you.

Thought provoking post with interesting concluding questions. I don’t think I’ve ever had a doctor ask about my mental state. Not sure I’d be comfortable with it. Key point: “In order to successfully negotiate these interactions a patient must trust that the doctor has taken the first and second step and isn't assuming they are crazy.”

queenofoptimism said...

I heart you, Doctor D. Thanks for another post that offers another perspective and gives us hope for improving our relationships with our doctors. Bravo!

Aviva said...

Ok, Dr. D, I officially have a crush on you now. :-) Thanks for a lovely post!

Anonymous said...

Is "supratentorial" ever used to mean anything other than all in your head?
If my doctor suggested that my symptoms were all in my head, I'd just ask for a referral to a psychiatrist.
It doesn't do me any good if he just writes it in my file without saying anything to me.

Anonymous said...

ok i think if u do not believe in chronic illness you shouldnt be a doctor ... becouse its true painfull and disabaling i have a desiese in wich my bones are fusing it is excruciating pain mind bending pain. because people cant see it on the outside doesnt mean im not soar on the inside one thing ive learned is how dumb people really are . you are blessed if u get this sight especially if u are young so u can teach others of what u know.

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