P05.08. Difficult Patient Cases: Paradigms, Teamwork, and Uncertainty

Focus Areas: Integrative Approaches to Care Patients who have medically unexplained symptoms are challenging for healthcare providers, are common in primary care and specialty care settings (Burton et al, 2002; Hatcher et al, 2007), and often present to integrative medicine practitioners. Difficulties arise for providers to validate the patients' concerns while not over-investigating symptoms as well as to maintain a therapeutic relationship. The mind-body duality of conventional medicine contributes to these difficulties, as it pushes providers to choose either a psychological or somatic diagnosis. Bakal identifies a concept of “body distress,” where “psychobiologic processes” have manifestation as symptoms, and over which patients can have some control (Bakal et al, 2008). This concept aims to transcend the limiting mind-body duality and so can identify a unique way to ameliorate suffering of folks with unexplained symptoms. This case study details a somaticizing patient (Mary) who has multiple unexplained symptoms. Using Bakal's notion as well as other notions of “imbalance” and “suffering” allows for more flexibility in working with such patients. The case study illustrates how these notions can provide a way to understand and guide an integrative approach over time and nurture the provider-patient relationship: (1) keeping patient and provider engaged in an open dialogue, (2) providing for new ways of describing such patients, and (3) identifying novel ways of helping such patients. Such an approach engenders creating interdisciplinary teams, placing emphasis on relationship as therapy, and continuing to remain open to psychological concerns. It also emphasizes the need to remain open to new (somatic) diagnoses that may emerge. These concepts arguably helped mitigate some of Mary's suffering while minimizing further unnecessary somatic investigation. At the end of the presentation, discussion and suggestions will be solicited from the audience.