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Blame, shame and hopelessness: medically unexplained symptoms and the 'heartsink' experience

  [ 6 votes ]   [ 2 Comments ]
By Louise Stone • • June 5, 2014

Note: You can read the full article here.

By Louise Stone


BACKGROUND: 'Heartsink' patients present a moral dilemma. We recognise their suffering, but at the same time struggle with the feelings they trigger in us. Patients also experience negative feelings. Without a diagnosis they lack a narrative or vocabulary to make sense of their own suffering.

OBJECTIVE: This article explores some of the challenges faced and strategies utilised when managing patients with medically unexplained symptoms.

DISCUSSION: Doctors and patients often experience frustration and helplessness in consultations around medically unexplained symptoms. Without a diagnosis, patients lack social legitimacy as 'sick' people with 'real' illnesses. They often describe feeling blamed for their own distress. Because of this, they can experience deep feelings of worthlessness and shame. Patients with a history of abuse can be particularly vulnerable. Management includes validating their suffering, helping them construct appropriate explanations for their distress and providing empathic interpersonal care, while minimising the risk of iatrogenic harm.

Source: Stone, Louise. Aust Fam Physician. 2014 Apr;43(4):191-5.

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Article Comments Post a Comment

Posted by: shianne7
Jun 6, 2014
This article is so important for "ALL" doctors to understand. My condition will get worse with any emotional stress. When I decided to seek medical help, going to a Doctor's appointment felt like running a marathon. It was so exhausting just to make it there. The lack of compassion that was shown by the doctors was so heartbreaking. I would be so sick that I thought I would die at anytime. Explaining to them how I am so ill and weak that I have to drag myself around the house. My family has been through hell and hoped they would help us get answers. My experience with every doctor I visited was humiliating and made my symptoms progress. This is a disease, disorder, condition that worsens with any stress related issue. To the point of wishing you could die. BEWARE of any doctor that tells you to take vitamin B, while laughing at the fact that you think you may be dying. ALTHOUGH, you have tried relentlessly to tell him of your symptoms with no prevail. The desperation of simply getting them to give me a test of some kind is absurd. Please people you took an oath to help the sick, not to betray them!! To those who have a doctor who is frustrated because they don't know how to help, tell them to start living by the oath that they took and refuse to conspire with insurance companies and pharmaceutical industries for money in exchange for lives. To those few compassionate doctors that really do care for the sick, I applaud your every effort and I an grateful for you!!!!! Please contact me if you live anywhere near Polk County, Florida because 25 years later still sicker than ever and no answers or advice or extensive testing. Just watching life pass me by.

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Posted by: Sassyquilter
Jun 18, 2014
Just wanted to say to the lady from Florida that I have also experienced the same treatment as you do here in Canada I also come from the dr feeling depressed and wishing I could die because of the dispassionate I and non care I get from my Dr.s for the last 25 years. I know where you are coming from.. Blessings
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