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Doctors training notes

You’re driving me . . . functional

As the stand-up comic puts it, it’s the way you tell ‘em. Doctors tend to think that most of their patients are mad, and imagining their symptoms. But how do you tell the patient that he is stark-raving bonkers in a way that does not cause offence? Well, medicine has a nice phrase for it - it’s ‘functional’.

In a study of 86 patients, doctors tested various terms to see which had the strongest connotations. Way out front was ‘symptoms all in the mind’, and 31 per cent of patients assumed this really meant that the patient was mad. Second was ‘hysterical weakness’, followed by ‘psychosomatic weakness’ and ‘medically unexplained weakness’. The survey participants all recognised these terms as ways of saying ‘you’re barking’.

But when doctors tried out the term ‘functional’, nobody batted an eyelid, and everyone thought this was a genuine medical condition (BMJ, 2002; 325: 1449-50).

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