Culture and Medicine Emotional dimensions of chronic disease. West J Med 2000;172:124-128

Advances in research and the delivery of health care have

reduced mortality from disease and extended life expectancy

in developed countries. We are living longer, but are

we necessarily living better? Those who would have died

from their condition may now survive but there is the

emotional cost of long-term treatment and medical surveillance

to consider (for example, the patient who has had

a liver transplant must then continue immunosuppression

treatment). Such patients must cope with a chronic condition

and yet the emotional dimensions of these conditions

are frequently overlooked when medical care is considered.

Concepts such as the “sick role” and “illness behavior”

have helped us understand the impact of disease

and are familiar to most clinicians. Yet challenges still exist

in the recognition and management of the psychological

and social dimensions of chronic illness.

Summary points

· The emotional dimensions of chronic conditions are

often overlooked when medical care is considered

· It can be difficult to diagnose depression in the

medically ill but diagnosis and treatment are essential

· Doctors may be well equipped for the biomedical

aspects of care but not for the challenges of

understanding the psychological, social, and cultural

dimensions of illness and health

· Clinicians can play an important part in helping their

patients to maintain healthy coping skills

· Clinicians should reflect on the emotional dimensions

of their work, including how professional development

and training may enhance professional satisfaction

and patient care, and the important role that

relationships and outside activities have in providing

balance