Ten Principles for More Conservative, Care-Full Diagnosis
Authors: Katherine Rediger, Bailey Miles
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Ten Principles for More Conservative, Care-Full DiagnosisKatherine Rediger, MSN, CRNP and Bailey Miles, MDKatherine Rediger, MSN, CRNPJohns Hopkins Community Physicians, Baltimore, Maryland (K.R., B.M.)Search for more papers by this author and Bailey Miles, MDJohns Hopkins Community Physicians, Baltimore, Maryland (K.R., B.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0146 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We were pleased to read Schiff and colleagues' commentary (1) and encourage medical providers to adopt the authors' approach. We believe that their principles are particularly applicable to trauma-informed care.Adverse childhood experiences and adult trauma are prevalent but often not acknowledged in a medical setting. Patients who have experienced traumatic events often feel a loss of control over their bodies, relationships, and lives. Their traumatic experiences, including adverse childhood experiences and adult trauma, may manifest as physical symptoms and increased health care use and costs (2). This association is consistent with our experience working with an ...References1. Schiff GD, Martin SA, Eidelman DH, Volk LA, Ruan E, Cassel C, et al. Ten principles for more conservative, care-full diagnosis. Ann Intern Med. 2018;169:643-5. [PMID: 30285046]. doi:10.7326/M18-1468 LinkGoogle Scholar2. Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med. 2001;134:917-25. [PMID: 11346329] LinkGoogle Scholar3. Kroenke K. A practical and evidence-based approach to common symptoms: a narrative review. Ann Intern Med. 2014;161:579-86. [PMID: 25329205]. doi:10.7326/M14-0461 LinkGoogle Scholar4. Elklit A, Christiansen DM. Predictive factors for somatization in a trauma sample. Clin Pract Epidemiol Ment Health. 2009;5:1. [PMID: 19126224] doi:10.1186/1745-0179-5-1 CrossrefMedlineGoogle Scholar5. Page LA, Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. J R Soc Med. 2003;96:223-7. [PMID: 12724431] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins Community Physicians, Baltimore, Maryland (K.R., B.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0146. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTen Principles for More Conservative, Care-Full Diagnosis Gordon D. Schiff , Stephen A. Martin , David H. Eidelman , Lynn A. Volk , Elise Ruan , Christine Cassel , William Galanter , Mark Johnson , Annemarie Jutel , Kurt Kroenke , Bruce L. Lambert , Joel Lexchin , Sara Myers , Alexa Miller , Stuart Mushlin , Lisa Sanders , and Aziz Sheikh Ten Principles for More Conservative, Care-Full Diagnosis Thierry Pelaccia Ten Principles for More Conservative, Care-Full Diagnosis James L. Meisel Ten Principles for More Conservative, Care-Full Diagnosis Gordon D. Schiff , Kurt Kroenke , Bruce L. Lambert , Lisa Sanders , and Aziz Sheikh Metrics 4 June 2019Volume 170, Issue 11Page: 822-823KeywordsChild healthConflicts of interestDecision makingDiagnostic techniquesDisclosureEmotionsHealth careMedical servicesPrevention, policy, and public health ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...