Hernia in General Practice

Abstract

particularly if the stress of an unpleasant job or boss or a distressing family situation cannot otherwise be handled. Temporary help with work at home or in an office may be indicated.Stopping smoking will often reduce nervousness and fatigue.It is wise to see that the patient understands that he will not necessarily have a smooth course. There will be ups and downs-good days and bad days-often without apparent cause. The patient may feel more exhausted after prolonged rest than he did before, especially if rest brings a let-down after a keyed-up period. THIRD PRINCIPLE-KEEPING THE PATIENT LARGELY SYMPTOM FREE AND PREVENTING RELAPSE Patients who are psychoneurotic and who are sub¬ ject to chronic fatigue and tension and anxiety states generally are vulnerable and likely to have relapses. Consequently, in management of patients with fatigue and nervousness it is important to educate the patient effectively and to aid him in maintaining a proper psychologic balance. Usually by the time he has completed his recovery or is much better the patient has learned fairly well how to manage himself. Most of all, he has recognized the causes of his previous difficulties and has learned to conquer and control conflicts.Barring unexpected strain, he should do reasonably well in preparing for blows and emotional shocks. The physician should ascertain that the patient knows his own limitations, that he knows the precipi¬ tating factors in his illness and that he recognizes the value of the various therapeutic procedures which, with the aid of the physician in whom he has confidence, have led to his recovery. Recognizing these factors, he should be able to manage to keep himself out of serious trouble and in rather good condition generally. How¬ ever, since his problem is a medical one, he should not hesitate to seek advice from his physician at regular intervals or when he gets into difficulties which he cannot resolve himself. PROGNOSISThe prognosis for patients with functional nervous disorders varies greatly and may be very difficult to estimate. In general, it is good for patients with simple tension and fatigue states, particularly when anxiety can be relieved and fatiguing work restricted and rest prolonged. Young persons with emotional and environmental problems which can be solved often improve remarkably and recover completely. For patients with significant constitutional inadequacy, pro¬ nounced emotional disturbance or prolonged economic and environmental problems to which the patient is not accustomed and which cannot be altered or for those patients who have had multiple operations with or without permanent physiologic disturbances, the out¬ look is not too good, but the patient can often be improved. Ten or 20 per cent improvement may be enough to make life worth living again. SUMMARY It is generally believed that one third to two thirds of all patients who seek medical help have as the most significant cause of ill health an emotional or neurotic disturbance. Fatigue and nervousness are the commonest symptoms of...