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Management Plans

Posted By Randall Reitz, Tuesday, September 13, 2011
Use this blog to suggest management plans (ie- family engagement, creation of shared understanding of symptoms that are painful or distressing but not biologically threatening, re-framing the problem, etc).

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David D. Clarke says...
Posted Tuesday, September 13, 2011
As a Fellow in Gastroenterology at UCLA in 1983, I became interested in Medically Unexplained Symptoms (MUS) after a psychiatrist cured a patient of mine using a few months of weekly counseling sessions. The patient had previously mystified our department and that of UCSD with 2 years of severe symptoms. The psychiatrist, Harriet Kaplan, uncovered the link between the patient's symptoms and a severe psychosocial stress which was then treated.

Subsequently, Dr Kaplan taught me her framework for evaluating MUS and I used this approach with success for about 300 patients annually until I retired in 2009. By inquiring into current life issues, a past history of child abuse or neglect and more subtle presentations of Depression, PTSD or Anxiety, the etiology of MUS can be uncovered and treated leading to improvement or resolution of the MUS.

There are significant barriers to wider application of this approach. Medical Clinicians are often reluctant to accept psychosocial issues as part of their domain. Mental Health Professionals (MHP) are often reluctant to accept physical symptoms as part of their domain. Patients are often reluctant to consider a psychosocial etiology for MUS. Fortunately, I have found MHP highly receptive to training in how to apply their existing expertise to relieve MUS. This training typically requires only 3-6 hours. Medical Clinicians with access to MHP trained in MUS have a strong incentive to screen for psychosocial links to their patient's illness. Patients who are then referred by a medical clinician to a MUS-trained MHP for a "Stress Check-Up" (rather than calling it by the more stigmatizing "Mental Health or Psych Eval"), will likely be much more willing to make and keep their MH appointments.

I am optimistic that the considerable shared expertise in our group could develop the concepts above into training for CFHA members and others in the future.
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