Misconception about psychosomatic problems


I know I should be studying, but let me write one more post.

A couple days ago, a friend of mine complained about a patient with psychosomatic disorder. She said that the patient should not ask for medicine, the patient should treat his/her own self. 

Some years ago, or maybe a year ago, I would think exactly like that. But, when I set my mind to be a psychiatrist. I know, I should think the way my patient think. I should put myself into their shoes. 

Even people with mental problems will come to a doctor complaining they have physical problems. Because they often do feel it physically. They feel their head spinning, their heart beats faster, their stomach is bloated, or they feel pain all over their body. And they are not doctors. They don't know what causing their pain. They don't understand if it's a real pain or not. That's why they seek for help.

It's our job, as doctors, to do all the examinations needed to find what is wrong with their body. If the physical checks are normal, but the patient still feels the pain. It is still our job to help them. 

Psychosomatic is listed in Indonesian competency standard for doctor as level 4A. It means that every general practitioner should be competent to treat the patient with psychosomatic problems. In fact, psychosomatic problems are not that simple to be treated by the general practitioner. The treatment of psychosomatic problems consisted of medical treatment using drugs and psychotherapy. So, it will not be cured only by medicines and "nice talk".

What we learn as general practitioner is only a tiny part of psychotherapy called psychoeducation. We cannot change the patient's mind about the disease they think they have just by telling them what they ought to do and what they don't. They will think that we simplify their complain. They will think that we don't think seriously about their pain. I think that psychosomatic is better to be listed as level 3A, meaning general practitioner can help reduce the pain by giving medicines but is required to refer the patient to psychiatrist. 

One more problem. Even in this modern era, most people still put negative stigma into mental problems or mental disorders. They think that as long as you put a good thoughts into your brain, you'll function just fine. But, the fact is, some people need help to put that good thoughts.

That negative stigma often prevents doctors to refer their patient with psychosomatic problems to the psychiatrist. Either they think that the patients can take care of their own personal feeling to feel better or they are afraid if the patients feel persecuted as they are referred to psychiatrist. Whatever the reason, it is clear that we should try to stop putting negative stigma into mental problems/disorders, including the patient and the doctor who take care of them.

"In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable." - Kevin Alan Lee, The Split Mind: Schizophrenia from an Insider's Point of View

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