International Journal of Body, Mind and Culture
Volume:4 Issue: 2, Summer-Autumn 2017

 Monajemi, Goli, and Scheidt (2014) proposed a theory of development of psychosomatic (PSM) reasoning. They hypothesized that the integration of psychosocial knowledge with biomedical (BM) knowledge may have started at the level of GPs. An experimental study was conducted to explore and compare junior and senior practitioners regarding their shift from BM to PSM in terms of their decision-making.

 Two cases were presented to GPs in a sequential manner based on the reports of different settings (inpatient vs. outpatient). Each participant read each part of the case carefully in order to provide the management plan (Mx), determine which parts of the scenario were the most important, and write down, first, an explanatory model, and then, the management plan for the patient. The accuracy of item selection, explanatory models, and management plans were analysed.

 GPs have already acquired some PSM knowledge, and thus, they will be able to differentiate between the two focuses (i.e., BM and PSM), but are not yet proficient enough to deal with a case in a PSM focus efficiently. This results in ineffective judgment. In other words, GPs discern the importance that should be given to psychosocial factors when examining their patients; however, they do not take into consideration such factors in the management plan.

 The results were largely in line with our assumptions based on the theory of the development of PSM reasoning; however, there is a definite need for more experimental studies here to support this argument.

Mental and psychosomatic problems and disorders are increasing and have become an enormous cost factor due to their chronification (increase in the periods of incapacity to work and a third of early retirement is due to mental disorders). A timely detection and targeted short-term interventions in primary care can, however, prevent their chronification. Patients desire the consideration of their psychosocial problems and emotional needs by their GP within the framework of professionally competent guided dialogues. Doctors with qualifications in psychosomatic basic care and an additional designation in psychotherapy are further trained for this and are able to intervene promptly and effectively.

Psychosomatic medicine developed in Germany after the Second World War as a multifaceted system of inpatient, day-patient, and outpatient treatment. The conceptual roots of post war psychosomatic medicine in Germany were in internal medicine (Victor von Weizäcker and Thure von Uexkuell) and in the psychodynamic and psychoanalytic tradition of G. Engels, Franz Alexander, and others. The implementation of psychosomatic medicine as a speciality of medicine in addition to psychiatry supported an integration of psychotherapeutic methods and interventions in medicine. Consultation-liaison (CL) services have contributed to the dissemination of psychosocial skills and interventions in the medical setting. Psychosomatic basic care curricula have improved the diagnosis and treatment of psychosomatic problems and disorders in primary care.

Somatoform disorder and somatic symptom disorder (SSD) are resistant to traditional medical support. Patients experience a vicious cycle of focused awareness/attention towards distressing bodily sensations. A negative interpretation of these phenomena leads to “worrying, cognitive styles” concerning the body (body-image, which enhances further self-awareness/self-observation) towards unpleasant bodily sensations and hyper-arousal. Body-psychotherapy may be one approach appropriate in dealing with these disorders and syndromes. This article addresses the concept of creative body-work, defines its basic guidelines and aims, and demonstrates a practical approach to support patient familiarization with body-self-experience and how to establish a basic contact (relationship) and control the vicious negative cycle. A positive working definition of somatoform disorder would include the following: illness perception and illness attribution; illness behaviour; health-related anxiety; emotional distress; disability; quality of life; doctor-patient-interaction and health care utilisation. This article relates to specific cultural aspects working with patients in China within a one-day professional workshop including clinical observations and analysis. It also refers to the gender perspective. Psychotherapy and psychosomatics more and more also have to consider these perspectives.

 Organizing the health system around family medicine (FM) has been a productive approach for developed countries. The aim of this study, which was concurrent with the Iran Health Transform Plan (HTP) and the establishment of the family physician in Iran, was to discuss the sufficiency of a family physician training program for their roles and increase their competency.

 This descriptive study was conducted in the Psychosomatic Research Center affiliated to Isfahan University of Medical Science, Iran, with the assistance of the Iranian Institute of Higher Health (2015). An expert panel consisting of 6 individuals including specialists, trainers, and researchers in FM and psychosomatic medicine was held for this purpose. Using the World Organization of Family Doctors (WONCA) website for the definition of a family physician, the curriculum developed by the Ministry of Health and Medical Education was studied. Data were summarized in one table.

 The current FM curriculum, with this content and method, does not seem to be capable of enabling physicians to perform their multidisciplinary roles. it still has a reductionist approach and disease orientation instead of a clinical reasoning method and systematic viewpoint. The psychosomatic approach is applicable at all prevention levels and in all diseases, since it is basically designed for this longitudinal (between all preventive levels) and horizontal (bio-physical-social-spiritual intervention) integration.

 Psychosomatic medicine, not as a biomedical specialty, but rather as a systems thinking model in health, had a rapid rise during previous decades. Now, its services have been integrated into all medical fields. This means that it should be adopted in the core of health care services (i.e., the family physician position) before other sections. This would help the implementation of this approach in the health system, and the reduction of patients' pain and uncertainty and improvement of their health. Thus, psychosomatic approaches for family physicians only emphasize on some of their fundamental acts.