The Psychological Approach to General Practice

WHEN the young physician leaves his teaching hospital to enter the field of general practice, he often finds great disparity between the clear-cut disease patterns of the hospital ward or medical out-patient clinic, and the symptom pictures of the private consulting-room. Finding himself unable to explain the latter in terms of pathology, in his bewilderment either he blames his teacher for having taught him falsely, or he explains his patient's symptoms (1) as being figments of the imagination, (2) as being cxpressions of such doubtful pathological entities as chronic gastritis, colitis, and rheumatism, conditions seldom seen in the autopsy room, and of whose disease-basis he is by no means clear. Modern teaching has attempted to clear the grouncl by postulating two opposite mechanisms producing the same symptoms, one based on demonstrable change in bodily structure, the second basedl on no such visible change, either at post-mortem or subsequent microscopic examination. 'The former group are termed the organic disorders. The latter, rightly attributed to disorder of function rather than of structure, are said to be "functional." It is the alarming preponderance of functionial disorder over organic disease, seen in the private consulting-room, that demands a rapid mental reorientation, which the practitioner is often unable to make. But make it he must, if he is to explain satisfactorily his patient's complaints. 'T'o fail in the endeavour is to court a sense of frustration, wlhich so often attacks the enthusiastic doctor in the middle years of general practice. It is the aim of this paper to aid that reorientation of ideas.