PTSD and the practitioner.

41 P art of the art of medicine, like in Goldilocks and the Three Bears, is getting it " just right " when it comes to under-diagnosing or over-diagnosing condi-tions—providing false negatives or false positives—in day-today practice. This is especially important, but problematical, when a new diagnosis appears on the scene because , in my experience, such new conditions often either continue to be unrecognized by some practitioners , or are over-recognized by others. Post-traumatic Stress Disorder (PTSD) is one such relative newcomer to " official " diagnoses. PTSD first appeared officially coded as such in DSM-III in 1980, although it had been known by various names before that: " soldiers heart, " " shell shock, " " traumatic neurosis, " or " Gross Stress Reaction, " to name several. Two papers in this issue of the Wisconsin Medical Journal deal with the under-recognition problem. Weis and Grunert point out that early identification and timely referrals of persons who develop PTSD following traumatic injuries results in better outcomes overall— not just in terms of symptom relief and recovery, but also in terms of reduced medical and mental health expenses, disability payments, lost wages, and other costs. The authors provide a brief, useful physician screening tool to help in such early recognition efforts, and a case example. They also provide a concise summary of contemporary treatment techniques for PTSD. A paper by Clardie outlines similar early identification techniques with a different group of patients in whom sexually traumatic experiences have triggered a Post-traumatic Stress Disorder, a highly emotionally charged and sensitive topic for both patient and doctor. The author suggests some specific questions, and ways of asking those questions, that the primary care physician, or OB-GYN specialist, can use in day-today practice so as not to miss clues to a possible PTSD aftermath to traumatic sexual events in the lives of these patients , yet at the same time do so in a non-threatening, empathic manner. The point of such inquires is to effect early identification and refer-ral of these persons for treatment to minimize traumatic aftermath. But PTSD can also be over-diagnosed. While it is true that some victims of traumatic accidents, natural disasters, and sexual trauma develop PTSD, many do not, and that is a credit to the overall re-siliency in most persons. Accidents, natural disasters and other traumatic events happen often. Victims respond to those traumatic events in …