Symptoms as medical currency

Question 1

Symptom iceberg

Answer 1

What is presented at GP is not much of the full story

Question 2

Problems of biomedicine (4)

Answer 2

• A disquieting number of symptoms do not have a pathological basis, they often mimic those that do.
• Applying a biomedical model can lead to wasted resources, iatrogenic harm, frustration for patients and doctors, effective management to be missed
• outcomes depend on factors not related to diagnosis and treatment (pharma, politics, patient knowledge, doctor patient relationship)
• Things can go wrong in cycle of symptom; presentation; assessment; negotiation; management

Question 3

Medically unexplained symptoms

Answer 3

A common presentation

Functional: IBS, CRPS, fibromyalgia

Question 4

Malingering, factitious and somatoform disorders

symptoms intentionally produced; conscious reason for symptoms

Answer 4

Malingering: ++
Factitious: +- (Munchausens e.g)
Somatoform:- -

Question 5

Pathology versus dysfunction

Answer 5

Pathology: Demonstrable structural changes in tissues/organs
Dysfunction: Disordered physiology or psychology which may occur independently of pathology

Can have dysfunction on y axis, pathology on x