RESUMEN
The phenomenon of somatization, which results in unexplained physical complaints, is ubiquitous in primary care settings although it often goes unrecognized. Medical training emphasizes the identification and treatment of organic problems and may leave physicians unprepared to recognize and address somatoform complaints. As a process, somatization ranges from mild stress-related symptoms to severe debilitation. Patients at the low end of the spectrum often respond to simple reassurance, but patients who are more impaired require interventions specifically designed to avoid unnecessary exposure to dangerous, costly and frustrating diagnostic procedures and treatments.
Asunto(s)
Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Estrés Psicológico/complicaciones , Diagnóstico Diferencial , HumanosRESUMEN
Somatization is the experiencing of physical symptoms in response to emotional distress. It is a common and costly disorder that is frustrating to patients and physicians. Successful treatment of somatization requires giving an acceptable explanation of the symptoms to the patient, avoiding unwarranted interventions and arranging brief but regular office visits so that the patient does not need to develop new symptoms in order to receive medical attention. Antidepressants may be helpful in many patients, as well as cognitive psychotherapy when patients are willing to participate in it. Typical problems in managing such patients can be addressed by relying on the continuity established through regular visits to the same primary care physician.
Asunto(s)
Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/terapia , Diagnóstico Diferencial , Empatía , Humanos , Estilo de Vida , Visita a Consultorio Médico , Educación del Paciente como Asunto , Trastornos Psicofisiológicos/complicaciones , Trastornos Psicofisiológicos/psicología , Psicoterapia , Materiales de EnseñanzaRESUMEN
Somatization is the experience of physical symptoms in response to emotional distress. It is common, costly, and frustrating to both the patient and physician. Successful treatment of somatization requires the physician to pursue a positive diagnosis rather than rely on a diagnosis of exclusion. Treatment consists of giving an acceptable explanation of the symptoms to the patient, avoiding unwarranted interventions, and arranging brief but regular office visits for which the patient does not need to develop a new symptom to receive medical attention.
Asunto(s)
Medicina Familiar y Comunitaria/métodos , Atención Primaria de Salud/métodos , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/terapia , Diagnóstico Diferencial , Humanos , Estilo de Vida , Visita a Consultorio Médico , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Trastornos Somatomorfos/etiología , Trastornos Somatomorfos/fisiopatología , Trastornos Somatomorfos/psicologíaRESUMEN
A 55-year-old man comes to you for a routine physical examination. He is a nonsmoker who takes no medications and has no signs of acute or chronic disease, and he has not seen a doctor in years. What blood work should you order for this patient? The authors of this article help you answer this question in light of recent advances in technology, restrictions in healthcare reimbursement, and increased sophistication in cost-benefit analysis for laboratory testing.
Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Recuento de Células Sanguíneas , Glucemia/análisis , Colesterol/sangre , Femenino , Humanos , Masculino , Mala Praxis , Persona de Mediana Edad , Estados UnidosRESUMEN
OBJECTIVE: To compare a heparin dosing nomogram using an initial infusion rate of 18 units/kg/h with physician-directed heparin prescribing and with a modified version of the nomogram adjusted for institution-specific data. METHODS: During consecutive phases of this cohort study, patients' intravenous heparin therapies were initiated and adjusted by using one of the following three methods: (1) physician-directed dosing, (2) a body weight-based dosing nomogram with an initial infusion rate of 18 units/kg/h, and (3) a body weight-based dosing nomogram with an initial infusion rate determined by the median dose of heparin (in units/kg/h) required to achieve therapeutic activated partial thromboplastin times (aPTTs) during the first two phases. The time required to achieve therapeutic aPTTs as well as the percentage of initial aPTTs in the therapeutic range were compared for the three phases. RESULTS: The heparin dosing nomogram in which the initial infusion rate was adjusted for our individual institution resulted in a statistically shorter median time until aPTTs were in the therapeutic range than did either the physician-directed dosing or unmodified nomogram groups (6.1 h in the modified nomogram group, 10.5 h in the physician-directed group, 21.5 h in the unmodified nomogram group; p < 0.05 for all differences). Use of the institution-specific nomogram resulted in the greatest percentage of initial aPTTs in the therapeutic range (84% in the 13 units/kg/h nomogram group vs. 47% in the physician-directed group and 18% in the 18 units/kg/h nomogram group; p < 0.05 for all differences). CONCLUSIONS: Use of a heparin dosing nomogram with an initial infusion rate of 18 units/kg/h resulted in prolongation of the time to reach therapeutic aPTTs. By modifying the nomogram for use at an individual institution, we reduced the time to achieve therapeutic range of aPTTs while still reducing the likelihood of excessive anticoagulation of patients.