Some doctors listen, carefully, to their patients. They listen first, consider, ponder, and make thoughtful suggestions.
But there are other doctors who dash into and out of the examination room and seem to get all slaphappy with psychiatric labels. Years ago, one such doctor ranted to a very sick friend of mine in this vein: “Listen, 95% of the things people come to see me about aren’t even real. They’re not sick; they just hate their jobs or can’t stand their husbands. And it builds up, and next thing you know, they’re in here, whining to me about all these aches and pains that miraculously disappear if they get a good night’s sleep or a decent day at work.”
This latter kind of doctor infuriates me because when I was in grad school, studying clinical psychology, I lived in terror of diagnosing a patient with a psychiatric disorder when, in fact, he or she had a medical disorder. The first thing I’d do with a new patient was to ask them to go see a doctor and explain that their shrink wanted them to be worked up, stem to stern. And what fascinated me was how often a patient who’d come in self-diagnosed as “deeply depressed” turned out to have mononucleosis or some other very real, and sometimes extremely serious, medical ailment.
On the other hand there are medical doctors who have very little training in psychology or psychiatry but who blithely toss around labels that can have a very destructive effect on a patient’s ability to be properly diagnosed and treated. I’ve had more than one patient tell me that once one doctor labeled them as having a psychiatric issue, most other doctors wanted nothing to do with them.
So, consider for example, vocal cord dysfuction (VCD). The fourth edition of Murray & Nadel’s Textbook of Respiratory Medicine notes that “VCD … has historically been considered a functional or conversion disorder with terms such as ‘factitious asthma,’ Munchausen’s stridor, or ‘hysterical asthma.'”
In fact, a more recent term, irritable larynx syndrome, has been introduced, in part to reflect the “greater appreciation that factors other than psychological problems, such as gastroesophageal reflux disease [GERD], posterior nasal drainage, neurologica dystonias, or intense irritant exposures can lead to laryngeal hyperresponsiveness.” [Ibid.]
In other words, Munchausen’s stridor is out. VCD is out. Irritable larynx syndrome is in. And what has historically been written off to a psychiatric etiology may well be due to a perhaps not-so-obvious physical problem.
Ah, but if I could only have a dime for every time “Munchausen’s stridor” appears in patient charts and files in the next year, I bet you I’d be well off. These labels are an easy way to quickly identify and dismiss troublesome or difficult patients. Those labels are sticky, and it takes quite some effort to get them off once they’ve been applied.
Reference: Balkissoon RD, Baroody FM, Togias A. Disorders of the upper airways. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA. Murray & Nadel’s Textbook of Respiratory Medicine, 4th ed. Philadelphia, PA: Elsevier Saunders; 2005.
Copyright © 2009 by Candace L. Van Auken. All rights reserved.