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Kaleidoscope of the heart: Redefining an 'illness'

Rika Kayama (Mainichi)

In autumn, psychiatric medical conferences are held across Japan, and I made my way to a few. Scholars and researchers present their findings at these events and as I need to often refresh my knowledge, I find that I particularly learn a lot from the presentations of young physiatrists.

    One presentation by a young doctor was about the fundamental problem of whether we can objectively decide if our patients have an "illness" we are supposed to cure. When a patient comes to my office complaining of difficulties, I usually answer, "OK, let's see what we can do." I listen to their claims and ask about their lifestyle in detail, and if the situation calls for it, I prescribe medication. Then I say, "Please come again next week," and schedule their next appointment.

    However, what that doctor was suggesting was apparently the recent idea that not all people who go to the hospital necessarily have a "sickness" that requires treatment to cure. In hospitals in Britain, all patients who go to the hospital must explain their condition at a general reception desk, and in some cases, they are reportedly told that there is no need for them to undergo medical treatment.

    For someone claiming chronic lower back pain, the reception desk might suggest doing volunteer work or something to get the person up and moving their body more. Of course, if it is clear that the person really has something wrong with their back, they will be directed to an orthopedic specialist. But barring that, the desk person will insist, "I don't think you are sick," and reportedly solve many of the issues with lifestyle guidance or exercise.

    Instead of saying, "It might be a serious illness, so you should get examined by a specialist and take tests," saying something helpful like, "There is no need to go as far as coming to the doctor, you can get better through stretching," will even perhaps make the patient happy and allow them to save time and money.

    Hearing about this in the presentation, I tried saying, "You don't need continuous treatment," to several of my patients who had come to me for the first time.

    "You can't sleep, huh? It might be insomnia, but it also might be simple difficulty sleeping that we all experience at one time or another," I said. "Stop drinking alcohol immediately before bedtime, and even if you have a nightcap, if you wait until you are sober before you try sleeping, then the quality of your sleep will improve. If that doesn't work, please contact me again."

    There were some people who felt anxious about having only one appointment where no medicine was even prescribed and asked, "Is that it?" However, the majority of the patients answer with a smile, "Ah, I'm relieved. I'll cut back on drinking at night."

    Even though someone may have something that appears to be symptoms, it doesn't necessarily mean they have an 'illness.' If the ailment can be cured through just lifestyle improvements or relaxation, isn't that a good thing? I think I would like to polish my skills as a physician who can solve an issue in a single visit. (By Rika Kayama, psychiatrist)

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