Psychiatric Interviews for Teaching: Somatisation
From Debs Storey
In this film, you see a GP talking to a patient who has repeatedly presented to the surgery for abdominal problems for which no organic cause has been found. The GP asks the patients at length about her symptoms. The information is already in the GP notes, but the GP knows that if the patient is to trust the advice given, she must first feel that the history has been heard and understood by the new doctor.
It is apparent that the symptoms are more problematic when the patient is lonely, and also apparent that her social life has greatly reduced since the problems began. The patient thinks that she has a medical problem which doctors have not yet diagnosed, and she requests more tests. Despite pressure, the GP holds firm that further tests are not needed. The GP avoids getting into an argument about whether the problems are physical or psychological by suggesting that both these factors may be contributing.
The GP then suggests that as the attempts at treatment so far have not worked, they might want to try a different approach for a few months, as a trial. The patient remains cynical, but does at least agree to come and see the GP again.
In conditions such as somatisation, it can be helpful for the patient to see the same doctor so that unnecessary tests can be avoided.