We are honored to publish them. All opinions are those of Lynne Jones. Read the previous diary here. Items in [ ] are editorial additions. But if they do want to talk, be able to listen. We have been told we need to cut them short if there are too many people with serious physical problems waiting. I was not expecting this. They have asked me to do my usual introductory session where I cover what I consider to be the most important psychological issues to understand about forced migration: that everyone has suffered loss, and lived through extremely stressful experiences; that they are all now living in the most astonishingly stressful conditions.
I explain how loss, grief and stress affect both body and mind and how we might help. This includes how we approach the sensitive issue of discussing their past experiences.
I ask one of the GPs what percentage of the problems she has encountered are somatic presentations of stress. Throughout the talk a stream of patients has banged on the clinic door in spite of the fact that Thursday is known to be staff day off, and there is notice up saying clearly that the clinic is closed.
But if someone does want to open up to you, listening may be the most important and healing thing you can do and it might actually save time. Because if they have had an opportunity to share whatever distresses them, and if they have physical symptoms which you think are connected, you can then explain how their distress affects the body, causing palpitations for example. This might prevent the patient returning multiple times with other aches and pains, and also decrease the amount of medication you prescribe.
A long time ago when I was a trainee GP, we had Balint groups, named after the famous Hungarian psychoanalyst who taught GPs including my mother that even in a time limited setting, it was important to pay attention to the patients underlying anxieties, rather than simply medicating the physical symptoms.
