Throughout this book we stress the importance of matching competent orthodox medical management with competent psychological management. Without the former, a doctor's efforts will be frustrated by the patient's unconscious resistance. Obvious examples are patients exhibiting so-called non-compliance - an insensitive term - in taking drugs, or those who for no apparent reason do not get better or frequently relapse.
Most doctors think all psychological work involves the expenditure of additional time. This is a misconception. The psychological managements recommended for most disorders described in the book may be carried out simultaneously with standard medical managements, and many such are notorious for the amount of general practitioner and hospital time and costly investigations they take up. Effective psychological management reduces both in the long run. Even in the minority of disorders which call for work at greater depth, e.g. MS, Crohn's disease, RA and AI diseases, which are disabling and refractory, and make heavy demands on the time and skills of all care givers in any case. Any additional time initially spent on this restricted group is soon repaid in lessened morbidity or remission.
Young doctors and students are often aware that emotional factors appear to have played a part in the onset or relapse of a patient's illness, but when they seek guidance about psychological management, they are unable to find any. This may be because books which claim to deal with "the psychosomatic approach" and "whole person medicine" either have confused the reader with much that is not psychosomatic at all or are profuse with generalisations, while lacking the details of management without which a doctor responsible for a patient with a psychosomatic disorder is likely to fail or suffer needless frustration.
The interested reader should not be put off if some of the finer aspects of verbal and non-verbal communication and management are not immediately obvious. Few students are able to distinguish difficult heart sounds until they have heard them several times and their ears have become attuned; similarly, considerable experience of palpations is necessary before one is able to feel a soft spleen. Although this book has not been written for liaison psychiatrists, whose work involves them with many disorders other than psychosomatic ones, some may find parts of it useful. It is unfortunate that they will always be unable to see more than a fraction of the people with psychosomatic disorders needing help, because there are so many.