Bodily symptoms: a new approach

As medicine deals increasingly with chronic disease and acknowledges the importance of patients' quality of life, there is an increasing need to address patients' symptoms. The traditional way of considering symptoms is only as indicators of disease pathology. In medicine, the focus is on bodily pathology and in psychiatry on psychopathology. The assumption is that the patients can then be categorized as medical or psychiatric and that treatment of bodily pathology and psychopathology respectively will effectively relieve their symptoms. This simple model is, however, increasingly proving to be inadequate. There is a new more integrated way of thinking about bodily symptoms. Rather than start with the pathology and then consider the symptoms, it suggests that we actively address both pathology and the symptoms themselves. The available evidence tells us that chronic symptoms usually have multiple causes and that to effectively treat them we often need combined physical and psychological management strategies. Consequently, symptom focussed care requires that we develop new systems for assessing and managing symptoms that run parallel with existing systems for managing bodily pathology. It is also driving a new area of research, symptom research. Finally, the symptom perspective should make us think about how we organise our currently fragmented approaches to symptom management and combine the pain medicine, palliative medicine and liaison psychiatry services into a more coherent approach to symptom management.