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Patients don’t think highly of the idea of seeing a psychiatrist for their physical ailments | (Pic- AFP)

A medical doctor does not always find a reasonably likely cause to account for her patient’s physical complaints.  This doesn’t happen after the first consultation, but in quite a few instances, after exhaustive investigations too. What is the poor doctor to do, in such cases?

The different options available are not all that attractive. To admit what may be seen as incompetence or ignorance is embarrassing, to say the least.  Much easier is the course of picking some vaguely plausible diagnosis and treating it. This may be undertaken in all honesty or be done on slightly questionable grounds. But then, what else is the unfortunate doctor to do?

Referring to another practitioner rarely helps, for patients with such ailments have often done the rounds. Directing to a psychiatrist is even less preferred; the doctor has already found out that psychiatrists generally do no more than prescribe a different
anti-depressant to the one she has already tried. And patients don’t think highly of the idea of seeing a psychiatrist for their physical ailments anyway. So the placebo or symptomatic treatments must go on until there comes the day when the farce cannot continue.

The logic appears to be that symptoms ‘in the mind’ must respond to a ‘mental’ drug. The cure-all for all mental conditions, other than schizophrenia and mania, happen nowadays to be antidepressants

Most patients obligingly move to another doctor, when lack of progress becomes obvious. Should they persist with the same one? They may eventually be told that the symptoms are at least partly ‘in the mind’. What choices are available to hapless people branded as exhibiting such imaginary symptoms? Getting annoyed with the doctor concerned and going to another is unfortunately the only feasible remedy. But this cures only the current doctor’s problem – of not knowing what more to do.  Patients who move to another practitioner generally continue to suffer their ‘imaginary’ symptoms under the new treatment. In desperation, some eventually do consult a psychiatrist or agree to such a referral. Many of them end up with a prescription for an antidepressant. The logic appears to be that symptoms ‘in the mind’ must respond to a ‘mental’ drug. The cure-all for all mental conditions, other than schizophrenia and mania, happen nowadays to be antidepressants – and the newer the better.

Pity the poor patients. And pity the poor doctors too.  Not, of course, if the patients have medical insurance (or enormous wealth). Then, we are all able happily to ride the merry-go-round indefinitely. Insured people hardly ever suffer ‘imaginary’ symptoms, anyway. Their real disease is always found, by at least the second doctor they consult, should the first not be obliging enough. And where lack of money is not an obstacle, the treatment can be made increasingly vigorous, until cure is finally admitted.