Physicians who fail to make organic diagnoses may label their patients as “somatizing,” “problem patients,” or even “hateful,” which results in patients feeling rejected.

No single theory adequately explains somatization (Kellner, 1990). A biopsychosocial approach to the phenomenon could help students understand how a variety of factors can lead to the presentation of somatic distress (Epstein et al., 1999). Students should understand the diagnostic criteria for somatoform disorders, the many somatic manifestations of affective disorders, and how analysis of their own reactions to patients can help them recognize possible somatoform disorders in their patients. They should also understand how to use the physician– patient relationship as a therapeutic tool for these patients (Hahn et al., 1994; Novack, 1987).

Early recognition and appropriate management of somatization may prevent needless medical workups, doctor shopping, and a further decline in health (Singh, 1998). A number of effective therapeutic strategies for somatoform disorders have been outlined (Barsky and Borus, 1999; Drossman, 1978; Goldberg et al., 1992), and students should be familiar with these and other approaches (Epstein et al., 1999).

Interactions Among Illness, Family Dynamics, and Culture

Family dynamics and culture have a significant influence on a person’s perception and expression of illness. In many cultures, for example, an HIV or AIDS diagnosis is perceived as shameful (Paxton, 2000). These feelings of shame and guilt can prevent infected patients from disclosing their HIV status to their families, with the result that they experience isolation and depression at a time when family support is most needed (Black and Miles, 2002; Kadushin, 2000; Kalichman et al., 2003). Physicians must be taught that such cultural biases can influence many aspects of medical treatment. In the case of mental illness, cultural factors influence whether a distressed person seeks help, what type of care is sought, what coping styles are employed, and how much stigma the patient attaches to his or her condition (U.S. DHHS, 1999). Culture also influences the meanings people attribute to their illness. Among some African Americans, Alzheimer’s disease is believed to reflect a life of worry and strain that affects the mind in old age (Dilworth-Anderson and Gibson, 2002). In Asian families, dementia is often viewed as an internal imbalance or lack of harmony. These interpretations of illness affect the type of medical care sought. Moreover, patient, sibling, and parental ages and the developmental stages of each family member affect when, where, and how care is sought, as well as how patients’ symptoms are manifested (Christ, 2000; Henderson and Gutierrez-Mayka, 1992; King and Dixon, 1996; Montgomery et al., 2002; Ritchie, 2001; Rothchild, 1994; Schiffrin, 2001; Sholevar and Perkel, 1990).

Medical students should learn to recognize how families and the communi-

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement