Mystery Illness: Idiopathic Slop
in Medicine, Pediatrics & Psychiatry
Blame Mom for Our Medical Ignorance!
When I was occasionally supervising the largest psychiatric ER in Philly about 400 years ago, we would often get patients with severe medical problems. We would send them up the hill to the respected regular ER run by an anti-psychiatry physician. If they had the slightest little psychiatric symptom, they would be "medically cleared" in a flash, and sent back to us.
Typically, since we were physicians also, we had to point out the signs of severe medical danger to the ER attending, sometimes even call the administrator on call, and have the patient sent up for a serious work up. Our actions saved lives, as these slop evaluations were redone appropriately and massive emergency problems were found.
Today, most physicians do not realize that because the brain is the most sensitive organ in the body, the norm is for persons with illness in other body parts to have some psychiatric symptom(s).
Today, we live in the world of the rushed routine evaluation. Physicians have been destroyed by totalitarian state boards that oppose chronic pain control and innovation, and where lawyers make paperwork the standard of medicine. Lawsuits now control all of medicine and my father's malpractice OB/GYN rates required him to use savings to be able to practice. Did you hear me? He paid to do his vocation! Insurance games and form processing requires hundreds of thousands in staff and equipment.
The trouble is that physician learning has been reduced to the least amount to be able to still practice. Most physicians are really in frantic survival mode, not "let me spend four hours trying find the cause of Mrs. Jones' probelm." Those four hours are now spent on insurance coding trouble. So the days of searching for a new treatment or an eccentric cause are gone for 99% of physicians. I am often amused at educated folks talking about big named medical centers with reverence. They talk of going to these medical "holy places" for the "big work up." Bluntly, I get many patients who were not helped by these IVY Centers, and when I look at the work-up they have had done, I am stunned at how canned and predictable and pathetic is the individual care given to these precious pateints. Some of these well known centers merely allow you to see more doctors in a shorter time. I suppose that might matter is you were going to die in two days, but really is over-stated. Other patients talk about "Dr. Big" who has a special departmental appointment. And that is meant to show what? They like boring committee meetings, university politics, and cannot survive without drug company grants?
We routinely see patients that have illnesses that should have been found, but the great sages talk themselves out of the diagnosis by limiting themselves to committee medical decision flow charts.
There are many illnesses that can be diagnosed, fixed in time, and allow someone to get back to living. If someone says you have an idiopathic problem, accept that they do not know what you have and go see some creative clinicians.
A psychiatric conference advertising a seminar that blames a child and their parents for a child's poor functioning:
This ... workshop focuses on ... pediatric chronic unexplained pain (CUP). Case studies will be used to discuss the principles and practice of a rehabilitative family-oriented treatment program that focuses on enhancing patient functioning, rather than on the symptoms. ...
The translation is that the physicians cannot control the pain, and so they will talk your child out of the pain, and use different coping strategies that do help a little, but really show they are blowing off the patient and their family. State Medical Boards and the DEA love this since they like to have chronic pain patients suffer instead of using pain medications.
Typically, families believe that the symptoms are due solely to an organic cause, despite lack of significant organic findings.
Translation from this sadistic medical talk: The family will not accept that we are Popes. They fear we are clueless and not really listening. So we will show we are listening by ignoring the medical, and shifting them to psychological coping techniques. The family is thinking their child might have a rare medical problem. We could not find it with our simplistic 1980's labs, and so it must not exist.
They often resist considering suggestions that psychosocial factors may be contributory to the development or perpetuation of CUP ...
These patients can be bad and uncooperative. They can refuse to accept our simplistic talk show psychologizing of the pain, and this "resistance" is not acceptable for the child's care. We know what is best for this child. We know the child better than the parent(s).
Consequently, health care utilization is increased (i.e. multiple diagnostic investigations, repeated emergency department visits, and prolonged hospital stays) ... Family physicians, pediatricians, and specialist in GI, rheumatology, endocrinology and neurology are frequently consulted.
These little patients and their parents are a pain. They keep coming in with medical complaints. They are a burden on us.
Attention to the symptoms is actively discouraged. The family is taught coping strategies for enhanced functioning. Similar programs exist which are oriented to coping and function rather on the pain symptom itself.
These folks sure do have a "special" program. They ignore the child's pain, and make sure they get the family to force the kid to do what is expected of him or her, such as going to school or going to bed. Pain is ignored. We call this "dissociation," or tuning out the world, and it is a defense mechanism mastered in Buddhism. If the parents and child want to comply with a special created medical Buddhism, they have that right. I just wish the medical team would be more aware of their religion, pull out the Buddhist Scriptures, and be honest about their unique religious modality.
Dedicated To The Millions of Patients Who Have Been Ignored and Dismissed ... You are Right!