A basic principle learned early in my study career is that a disorder cannot be viewed in terms of its pathological mechanisms alone, but also its psychological and social dimensions. We are taught to treat each patient with dignity, integrity and to the best of our ability.

I had encountered a patient referred to physiotherapy for assistance with upper neck and back pains with radiculopathy. The onset of this complaint was following a mild – severe injury at work which occurred 9 years ago (employed as a health professional). Her cervical spine was cleared both clinically and radiologically with no resulting physical impairment. This patient has an extensive history with the local clinic, her private Doctor and local physiotherapy.

I felt a need to assist this patient as her situation was relatable – my profession too has room for injury. During the assessment, I picked up on a few “yellow flags” and inconsistency in subjective responses to physical examination. She seemed to be worried about hypothetical cases of her becoming injured. As much as I tried to lead the subjective interview into a more positive light, she would not stop ranting about each small pain and what it could possibly mean.

I started to think that Miss S was displaying some sort of “illness behaviour” and paranoia regarding her condition. She reported self-research into conditions she thought she may have and came up with treatments which she believed she would benefit from (treatments which were very expensive and according to my medical knowledge – were inappropriate). This seemed to occur during each appointment, with a constantly varying presentation and apparent disappointment when “massage” was not part of the session.

Illness on its own may be considered as the experiences lived by the patient an family and includes the meaning given to the experience by the patient. (Larsen, 2017). Illness behaviour may be defined as the varying ways which individuals respond to bodily indications, how they monitor internal states, define and interpret their symptoms, take curative measures and use various sources of formal and informal care. (Sirri, Fava & Sonino, 2013). Naturally, this concept varies widely in terms of illness-, patient- and doctor-related variables along with their interactions. Common aspects brought to light in the literature pertaining to illness behaviour include negative illness perception, frequent attendance at medical facilities, health care- & treatment-seeking tendencies. (Sirri, et. al., 2013) These qualities were all displayed by my patient.

I tried to reassure her and attempted to explain possible causes of her symptoms and the current and future implications thereof – which, in my mind, where not in any way a threat to her overall health and function. I tend to be a very patient person and always give people the benefit of the doubt. I was able to book her 3 follow up appointments consecutively, each of which testing for certain faulty structures turned out negative or “didn’t make sense”. I started to sense a pattern in terms of her medical history and various clinical presentations. I ended up referring her to the doctor, as suggested in the referral letter if no improvement occurs with physio.

My lingering conscience was questioning whether I had made the right choice, being giving up and settling for a referral. Should I have done more, booked her again and continue searching for the true structure at fault? I feel as if I let myself down and done this patient a wrong by simply referring her to the doctor and not having more patience with her or taking her seriously. This leads me to question my own judgement and integrity as a health professional, as I strive to always act honestly and with true sincerity.

The following statement regarding stood out to me:

“When a veterinarian diagnoses a cow’s condition as an illness, he does not merely by diagnosis change the cow’s behaviour, however; when a physician diagnoses a humans condition as such, he changes man’s behaviour by diagnosis.” (Larsen, 2017)

A perspective outlined by (Larsen, 2017) explains that patients may construct their own illness representations to assist them in making sense of their condition. A framework with which to manage patients with chronic conditions differs form that of an acute, episodic condition and is aimed toward prevention of medical crises, controlling symptoms and confronting underlying personal stressors.

I have learnt that illness behaviour is not irregular, nor something that can be “fixed”. Thus, the best outcome for similar patients is simply supporting, remaining positive and assisting the patient through the illness experience. (Larsen, 2017)

References:

Larsen., P. (2017). Lubkin’s Chronic Illness (10th ed., pg. 28 – 28, ch. 2). Wyoming: Jones and Bartlett Learning.

Sirri L, Fava G, A, Sonino N: The Unifying Concept of Illness Behavior. Psychother Psychosom 2013;82:74-81. doi: 10.1159/000343508