James McSherry, MB, ChB
McSherry J. Functional Somatic Syndromes. Ann Intern Med. 2000;132:327. doi: 10.7326/0003-4819-132-4-200002150-00015
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Published: Ann Intern Med. 2000;132(4):327.
TO THE EDITOR:
Barsky and Borus (1) have given us an erudite and elegant article on functional somatic syndromes. They proffer cogent arguments against an organic basis for a variety of clinical syndromes, including candidiasis, hypoglycemia via the sick building syndrome, and mitral valve prolapse. I agree that patients become trapped in a “sick role” when the continuation of benefits depends on symptom persistence and that the adversarial nature of claiming sickness benefits inhibits recovery by reinforcing the severity of disability.
I'm less impressed with their argument that certain conditions are less common when they are not covered by health insurance. My experience in thirty-something years as a family physician leads me to suggest that persons with conditions for which they do not receive benefits simply change their employment and never appear in the occupational health statistics. We should perhaps blame increased specialization and lack of flexibility in the work environment for poor symptomatic outcomes and prolonged rehabilitation instead of unresolved previous psychic trauma.
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