Crocks, Quacks, and Shrinks

Abstract

In 1950, health care costs accounted for 4.6% of the gross national product. In 1985, health care costs accounted for 10.8% of the gross national product (Cohen, 1985). Sophisticated biomedical technology and expensive medical tests have contributed to this cost escalation (Culliton, 1978). This massive increase in health care costs appears to have occurred without a comparable increase in health status (DeLeon & VandenBos, 1983) of United States citizens as measured by morbidity, mortality, longevity, and so on.

Pain syndrome patients, in their desperate search for the elusive cure, often chase “windmills” and convince their doctors to perform a myriad of invasive tests and procedures. As a result of their pain behaviors, many experience iatrogenic complications, suffering and disability. Those involved in their treatment must find improved ways to detect this highly susceptible population, establish a therapeutic alliance and short-circuit their pain careers.... Do the health care providers truly get to know the patients and their psychosocial dilemmas which, as studies indicate, often contribute to or cause the medical complaints? Or is this lack of rapport an unavoidable consequence of the increasing depersonalization within the medical system? The now antiquated model of the physician-healer who visited the patient’s home has been replaced by the all too frequent scenario of the patient who takes a tranquilizer before going to the physician’s office.

—G. M. Aronoff, M.D., The Clinical Journal of Pain, 1985