Psychiatric Interviews for Teaching: Somatisation

Summary

Dr. Betty meets Barbara, a patient with chronic stomach issues since a trip to Egypt four years ago. Despite treatments and tests, Barbara's symptoms persist, affecting her daily life and causing her to stop work and social activities. Dr. Brown suggested it might be stress-related, but Barbara seeks further tests. Dr. Betty proposes a different approach, focusing on Barbara's lifestyle and emotional well-being, suggesting a reevaluation of her medication and exploring activities that could improve her quality of life.

Takeaways

• 👩‍⚕️ Barbara Roberts is visiting Dr. Betty, a new GP, for a stomach issue that has persisted for years.
• 🌴 The symptoms began after a holiday in Egypt four years ago, following a severe bout of sickness and diarrhea.
• 🤕 Barbara describes symptoms such as bloating, constipation, diarrhea, cramping, and stabbing pain, which greatly affect her day-to-day life.
• 💊 She has tried various treatments, including prescribed medications and herbal remedies, but nothing has fully alleviated her symptoms.
• 🩺 Barbara has had some medical tests, including a gastroscopy and barium enema, but no definitive diagnosis has been reached.
• 💼 Her condition has significantly impacted her quality of life, causing her to quit her job and give up social activities like exercise and going out with friends.
• 😟 Barbara expresses concerns that her symptoms might indicate something more serious, such as cancer, especially after her mother-in-law passed away from an undetected growth.
• 🤔 Dr. Betty suggests that stress or emotional factors could be linked to Barbara's symptoms, noting that they seemed to improve during her son's wedding, a positive event in her life.
• 📅 Dr. Betty proposes a new approach focused on lifestyle changes and rationalizing Barbara’s medication, instead of ordering more medical tests immediately.
• 📝 Barbara agrees to return for a follow-up appointment next week to discuss her symptoms further and review her current medications.

Q & A

What is the main reason Barbara decided to see Dr. Betty instead of continuing with Dr. Brown?

Barbara decided to see Dr. Betty because she feels Dr. Brown hasn't been able to find the cause of her stomach problems and hasn't sent her for enough tests. She hoped Dr. Betty, with a fresh perspective, might offer new insights or suggest different tests.

How long has Barbara been experiencing her stomach issues, and when did they start?

Barbara has been experiencing her stomach issues for about four years. She believes they began after a holiday in Egypt, where she had a severe bout of sickness and diarrhea.

What treatments has Barbara tried for her stomach problems so far?

Barbara has tried various treatments, including muscle relaxants prescribed by Dr. Brown and different herbal remedies from a health shop. She also carries Imodium with her for diarrhea, using different tablets based on her daily symptoms.

What tests has Barbara undergone for her stomach issues, and what were the results?

Barbara has undergone a gastroscopy and a barium enema. However, neither test showed any significant findings, which left her unsatisfied with the outcome.

How have Barbara's symptoms affected her daily life?

Barbara's symptoms have had a significant impact on her life. She went from working full-time to part-time, and eventually stopped working altogether. She also stopped participating in social and recreational activities like meeting friends, exercising, and going out for meals with her husband.

Has Barbara noticed any periods when her symptoms improved or worsened?

Yes, Barbara noticed a significant improvement in her symptoms during the time leading up to her son's wedding, where she felt well for about three weeks. On the other hand, her symptoms tend to worsen when her husband is away, possibly because she feels more stressed or lonely.

What does Dr. Brown think is causing Barbara's symptoms, and how does she feel about his diagnosis?

Dr. Brown believes that Barbara's symptoms are caused by stress, implying that they may be psychological. However, Barbara disagrees, as she experiences real physical pain and doesn't think it's all in her head.

What concerns does Barbara have regarding her symptoms and potential diagnoses?

Barbara is worried that her symptoms could indicate something serious, such as cancer, especially because her mother-in-law died of cancer that was initially overlooked. She sometimes feels anxious and checks her abdomen at night for any changes.

What approach does Dr. Betty suggest for addressing Barbara's symptoms?

Dr. Betty suggests that instead of focusing on more tests, it might be helpful to consider a different approach. This would involve addressing the emotional and lifestyle aspects of Barbara's life, potentially reducing her symptoms by improving her overall well-being and resuming enjoyable activities.

What does Barbara hope Dr. Betty will do for her during their consultation?

Barbara hopes that Dr. Betty, as a new doctor with recent training, might be able to suggest new tests or treatments that Dr. Brown hasn't considered. She believes there may be new developments in medicine that could help her.