Virtually every symptom that can be the result of a physical illness may also arise from a non-physical cause. Lack of energy, stomach aches, headaches, pains anywhere in the body, inability to walk or to talk, and difficulties with hearing/sight may all occur for non-physical reasons but be equally as disabling as if a physical illness were present.
Assessment of physical symptoms
As a health professional your main task will be to assess, diagnose and provide treatment for the physical conditions for which patients attend the clinic. However, research has shown that for a number of patients who come to clinics with physical symptoms (perhaps one in four or one in five), it is not possible to make a medical diagnosis. This is true for children as well as adults. These children need your help just as much as those for whom a physical diagnosis can be made.
In this chapter we provide a general account of ways you can be helpful for the children who fall into this group. Many health professionals find patients for whom a physical diagnosis cannot be made very irritating. They may even get frustrated and angry with these patients. But if you become interested in this type of problem, you will find dealing with it just as rewarding as the rest of your work. How to assess the problem will depend on the main problem the parent talks about.
Assessing a physical symptom or symptoms
Your first task is to find out whether the child has a physical illness or disorder. In a number of children that you see, it is either not possible to make a diagnosis of a physical illness at all or a physical problem is present but cannot account for the degree of disability that the child is exhibiting. This chapter aims to help you to deal with these common situations.
A 7-year-old boy, Ali, is brought to you with moderately severe abdominal pain. He is not going to school or playing with his friends. He is eating normally. There is no vomiting or diarrhoea. When you examine the boy you find he looks well, is growing normally, has no temperature, has a normal pulse rate and when you press on the abdomen, there is no localised tenderness or rebound tenderness. The urine is normal. You decide that there is almost certainly no physical illness present.