Study more of the literature on Existential and Psychoanalytic Medicine (See the list of ‘Recommended Reading’ at the end of this book and on www.existentialmedicine.org.uk.)
If you are in private practice, consider extending at least your initial consultations with each patient to up to an hour – to allow time to gather more information about their lives, life world and life history.
If you are working as a GP in the public health system:
Ask more questions about the patient’s life and not just the symptoms they present with.
In particular, take opportunities to ask questions of the sort listed in the section of this book called ‘What Most Doctors Don’t Ask’.
For even within a very time-limited consultations it is possible to gather at least some information on the life context of a patient’s symptoms by opening a consultation with a friendly general question such as ‘How are things going?’ – giving time for the patient to offer more than just a superficial answer.
When a patient reports symptoms, ask ‘Had anything been troubling you before the symptoms started?’
Allow yourself to reflect on and share with the patient any possible symbolic or metaphorical dimension to a patient’s symptoms, relating to their current life problems and circumstances.
Example: itching or sensitive skin:
“Anything you’ve been itching to do?” “Anything you’ve been feeling particularly sensitive to recently?”
Example: stomach, digestive or bowel symptoms:
“Anything you’ve found hard to stomach/digest/get out of your system recently?”
Ask for and make notes of dates – not just the patient’s date of birth but the birth and/or death dates of relatives, siblings or spouses. You can do this in the course of asking about diseases in the family such as diabetes, cancer or heart disease.
Be aware of the timing of appointments made by patients – these may coincide with the timing of significant events such as births and deaths of people whom the patient identifies or feels a strong connection with.
Be aware that genetic explanations of illness may disguise something completely different – a strong psychological feeling towards and/or identification with a member of the patient’s family. The fact that illnesses are transmitted across generations does not mean that the mode of transmission is principally genetic.
Always find a way to ask the patient what’s been going on in their mind in relation to their symptoms, for example the question:
“What sort of thoughts and feelings have you been having about your (…..)?”