Symptoms of Unknown Origin

For years after graduating from medical school, Dr. Clifton K. Meador assumed that symptoms of the body, when obviously not imaginary, indicate a disease of the body—something to be treated with drugs, surgery, or other traditional means. But, over several decades, as he saw patients with clear symptoms but no discernable disease, he concluded that his own assumptions were too narrow and, indeed, that the underlying basis for much of clinical medicine was severely limited.

Recounting a series of fascinating case studies, Meador shows in this book how he came to reject a strict adherence to the prevailing biomolecular model of disease and its separation of mind and body. He studied other theories and approaches—George Engel’s biopsychosocial model of disease, Michael Balint’s study of physicians as pharmacological agents—and adjusted his practice accordingly to treat what he called “nondisease.” He had to retool, learn new and more in-depth interviewing and listening techniques, and undergo what Balint termed a “slight but significant change in personality.”

In chapters like “The Woman Who Believed She Was a Man” and “The Diarrhea of Agnes,” Meador reveals both the considerable harm that can result from wrong diagnoses of nonexistent diseases and the methods he developed to help patients with chronic symptoms not defined by a medical disease. Throughout the book, he recommends subsequent studies to test his observations, and he urges full application of the scientific method to the doctor-patient relationship, pointing out that few objective studies of these all-important interactions have ever been done.

For years after graduating from medical school, Dr. Clifton K. Meador assumed that symptoms of the body, when obviously not imaginary, indicate a disease of the body—something to be treated with drugs, surgery, or other traditional means. But, over several decades, as he saw patients with clear symptoms but no discernable disease, he concluded that his own assumptions were too narrow and, indeed, that the underlying basis for much of clinical medicine was severely limited. Recounting a series of fascinating case studies, Meador shows in this book how he came to reject a strict adherence to the prevailing biomolecular model of disease and its separation of mind and body. He studied other theories and approaches—George Engel’s biopsychosocial model of disease, Michael Balint’s study of physicians as pharmacological agents—and adjusted his practice accordingly to treat what he called “nondisease.” He had to retool, learn new and more in-depth interviewing and listening techniques, and undergo what Balint termed a “slight but significant change in personality.” In chapters like “The Woman Who Believed She Was a Man” and “The Diarrhea of Agnes,” Meador reveals both the considerable harm that can result from wrong diagnoses of nonexistent diseases and the methods he developed to help patients with chronic symptoms not defined by a medical disease. Throughout the book, he recommends subsequent studies to test his observations, and he urges full application of the scientific method to the doctor-patient relationship, pointing out that few objective studies of these all-important interactions have ever been done.
Reviews
	“Clifton Meador is undoubtedly a gifted clinician but his greater gift is his uncanny ability to capture and define the problems in medicine for which there are no easy labels and no easy cures. Meador’s thoughtful, anecdotal style allows every reader entry into that most complex of subjects: body and mind in health and disease.” -- Abraham Verghese, author of My Own Country and The Tennis Partner
	“Clif Meador does it again -- a new book for physicians about patients who suffer in bewilderment with strange illnesses they do not understand. His stories and approach to ‘symptoms of unknown origin’ are compelling and thoughtful. Medicine is rarely cookie-cutter nor simply linear from the structure and process of molecular knowlege. The lost art of being a detective and talking productively to ‘odd’ patients is a special craft in much need of resurrection. The approach in this book makes a superb dent in the problem. Meador’s accumulated wisdom from practicing endocrinology for over fifty years is a great read that doesn’t disappoint.” --Eric G. Neilson, M.D., Chairman, Dept. of Medicine, Vanderbilt University School of Medicine, author of Immunologic Renal Diseases
	“Clifton Meador is a master clinician. This book adds to his legacy. He does not allow preconceived notions to interfere with his need to listen to his patients. He elicits their narrative of distress so that he can minister to the illness they are experiencing. SYMPTOMS OF UNKNOWN ORIGIN offers lessons for all who feel compelled to seek medical care, and for all who assume responsibility for providing such. Meador makes his points by relating clinical anecdotes in prose that is lucid and engaging.” -- Nortin M. Hadler, M.D. University of North Carolina at Chapel Hill
	“The 50-year span of Dr. Meador's career has seen almost unimaginable changes in how physicians are educated, what practice is like, and what academic environments are like. Through this, Dr. Meador illustrates the importance of being a true physician with knowledge of the scientific but also the ability to communicate with patients and understand their illness from their point of view. This book would make a wonderful graduation present for a medical student - a way to help them understand that they have to think of their own career as an odyssey for them to control, as well as to help them understand that while in school teachers were appointed faculty, but once in practice their patients will be their most influential teachers. What Dr. Meador offers is an example of how to be a continuously learning physician, to keep an open and inquisitive mind, strive to listen, and not prematurely judge. This message might be equally important for experienced physicians, to remind us in these increasingly cynical times of the source of joy in practicing medicine.” - Stuart C. Gilman, MD, MPH, University of California, Irvine