Dr. Bob,

I have noticed something in common between yourself and other doctors I have talked to. Doctors don't want to tell a patient that they don't have the answers to their problems, so they diagnose your illness as 'psychosomatic' after trying out a couple of other things.

If a detective cannot solve a crime he runs the risk of being labelled incompetant. As a business analyst, I am often faced with tough problem to resolve and I don't have the option of falling back on an old standby like, 'sorry but that problem is unsolvable, it has no answer'. No, I either have to research until I solve the problem or come up with the best possible resolution given the information available.

Doctors on the other hand, will test you for HIV and maybe one or two more things. If by your third visit, they still haven't found a real diagnosis for your condition, they reach for the ever so handy and almost impossible to refute, "your issue is psychosomatic".

What a cop out! Is this something that is standard curriculum at all med schools? Every doctor seems to be ready with their "psychosomatic" diagnosis, ready to whip it out of their back pocket once they start to worry that they can't fix you properly.

Just an observation that I'm sure many people who write to your board can relate with...

Hello,

Psychosomatic illness a copout? No, actually it is indeed a very real diagnosis that some patients, like you for instance, have difficulty accepting. Psychosomatic illness involves both the mind and the body ("psycho" and "somatic"). In other words, the condition can be emotional or mental in origin, but have very real physical symptoms or consequences. Psychosomatic illnesses are not imaginary. They are very real physical disorders in which both emotions and thought patterns play a central role. Stress is often a key component. Take, for example, an extremely stressful event, such as the loss of one's spouse or lover. An individual might respond by developing high blood pressure shortly thereafter or even have a heart attack. Another person with exactly the same stressful situation might get a peptic ulcer or asthma attack. A third person, equally grief-stricken, might not get sick at all. An astute physician should be able to recognize and diagnose psychosomatic illness. I should also mention that once diagnosed, psychosomatic conditions are indeed treatable.

You report you've noticed something in common between me and other physicians you've talked to. Apparently we all agree you might be suffering from psychosomatic illness. You seem unwilling to accept this diagnosis. We can "fix you properly" only when you are willing to be fixed.

Dr. Bob