Being a botanist and a gardener: using diagnostic frameworks in general practice patients with medically unexplained symptoms
Louise Stone
+ Author Affiliations
- Author Affiliations
Centre for Values, Ethics and The Law in Medicine, Medical Foundation Building, University of Sydney, 92–94 Parramatta Road, Camperdown, NSW 2050, Australia. Email: louise.stone@gpet.com.au
Australian Journal of Primary Health 19(2) 90-97 https://doi.org/10.1071/PY11120
Submitted: 26 September 2011 Accepted: 26 April 2012 Published: 7 June 2012
Abstract
Patients with multiple medically unexplained symptoms commonly seek treatment in primary care. Many of these patients seem to have a psychological ‘core’ to their illness that affects the way they experience, conceptualise and communicate their distress. There is considerable debate around diagnosis for this group of patients. Existing diagnoses include somatoform disorders in psychiatry and functional disorders in the medical specialties. Some clinicians use the term ‘heartsink’ patients, which reflects the interpersonal frustration inherent in some therapeutic relationships. A good diagnosis should be clinically useful, helping clinicians and patients understand and manage illness. Diagnosis should also provide a reliable classification for research and evidence-based treatment. The allegory of the botanist and the gardener has been used to describe diagnosis. For the botanist, a good diagnosis produces a taxonomy that is rigorous and reliable. For the gardener, it informs the way a garden is described and understood in a specific context. Clinicians need both: a ‘botanical’ type of classification to bring rigour to research and therapy, and clinical ‘gardening’, which allows for multiple perspectives and diagnostic frameworks. Clinical reasoning is a form of research with therapeutic intent. Botany and gardening represent a mixed-methods approach that can enrich diagnosis. The challenge is to integrate multiple perspectives in clinically helpful ways that help us retain both richness and rigour.
Additional keywords: chronic illness, diagnosis, mental health, somatoform disorders.
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