The problem of pain in the clinicopathological method.
The problem of pain in the clinicopathological method.
复制标题
临床病理学方法中的疼痛问题。
DOI：
10.1097/00002508-199809000-00005
复制
发表时间：
1998
期刊：
影响因子：
--
通讯作者：
Sullivan,M
中科院分区：
文献类型：
--
作者：
Sullivan,M
The clinicopathological method provides the foundation for modern scientific medicine. Since its inauguration in France around 1800, it has been modified and supplemented but not replaced as the scientific basis for clinical medicine. Physicians define themselves and their job in terms of this model. In medical school, all physicians are trained to diagnose and treat disease. Indeed, we are taught that it is our job to be search-and-destroy engines for disease. We are taught that real disease can be identified by tissue pathology. Pain is important medically because it points to real disease. The most important diseases are those that can kill us. We thus view pain through the prism of disease and death. It is telling that John Liebeskind thought it necessary to prove to physicians that" pain can kill" in order to get physicians to take pain seriously. 1As primary care physicians leave training and enter practice, they realize that most of their patients' symptoms are not caused by disease. But they have no scientific method to determine the causes of these symptoms and dictate appropriate therapy. The result is frustrated physicians and dissatisfied patients who blame each other. Physicians live for those few patients a day who have" real disease" on whom they trained in medical school and residency. Patients walk away thinking that their physician considers their problems" all in my head." Alternately, physicians and patients collude in the" disease search" by ordering expensive tests and performing invasive procedures. This search is justified by the one in a thousand magnetic resonance imagings (MRIs) done for headache that shows disease. Not only are physicians taught that it is a mortal sin" to miss the diagnosis," they are provided by their medical training with no alternative scientific approach to symptoms.
