Davidhizar R, Cramer C
Bethel College, Mishawaka, Indiana, USA.
Radiol Manage. 2001 Sep-Oct;23(5):40-5.
The presence of physical symptoms that do not correlate with a disease process are often frustrating to healthcare professionals, are difficult to diagnose and may consume an inordinate proportion of healthcare resources. However, proper and complete physical and psychological assessment and treatment is becoming increasingly possible and essential. Physical illness may occur concomitantly and sometimes as a result of psychological distress, which has displayed itself in a diagnosed mental illness. In other cases physical symptoms may be caused by unconscious dynamics, and the process becomes the primary presenting mental concern. In other cases the physical illness is part of a conscious process and motivated by the hope of gain. Differentiation between physical symptoms of unconscious and conscious origin is important in selecting the correct response. A manager must first of all be alert for physical symptoms that appear to be consciously motivated, as in a disorder called "malingering." The essential feature of malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. Managers may inadvertently encourage malingering in the workplace by inappropriate responses to employees who present a physical complaint that is consciously motivated for gain. When the manager can recognize this phenomenon as malingering, appropriate managerial intervention can cause this behavior to be controlled and even eliminated and thus enhance productivity.
存在与疾病进程不相关的身体症状,这常常令医疗保健专业人员感到沮丧,难以诊断,且可能消耗过多的医疗资源。然而,进行恰当且全面的身体和心理评估及治疗正变得越来越可行且至关重要。身体疾病可能会同时出现,有时是心理困扰的结果,心理困扰已在确诊的精神疾病中表现出来。在其他情况下,身体症状可能由无意识的心理动力引起,而这个过程就成为主要呈现的心理问题。在其他情况下,身体疾病是有意识过程的一部分,且是出于获利的希望。区分无意识和有意识起源的身体症状对于选择正确的应对措施很重要。管理者首先必须警惕那些似乎是有意识引发的身体症状,比如在一种叫做“诈病”的病症中。诈病的本质特征是故意制造虚假或严重夸大的身体或心理症状,其动机是诸如逃避工作或获得经济补偿等外部诱因。管理者若对那些出于获利目的而提出身体不适申诉的员工做出不恰当回应,可能会在工作场所无意间助长诈病行为。当管理者能够将这种现象识别为诈病时,恰当的管理干预可以控制甚至消除这种行为,从而提高生产力。