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Q: Syndrome concept ( Answered 5 out of 5 stars,   4 Comments )
Subject: Syndrome concept
Category: Health > Conditions and Diseases
Asked by: dont_look_down-ga
List Price: $10.00
Posted: 19 Jul 2003 21:32 PDT
Expires: 18 Aug 2003 21:32 PDT
Question ID: 232952
Conditions such as attention deficit disorder and alcoholism can often
go undiagnosed by the person with the condition, the people around
them, and clinical professionals for a very long time. At the same
time, society provides disincentives for acceptance and diagnosis,
such as managed care dynamics and stigma, and destructive responses to
the behavior and symptoms of these conditions. Is there a term that
any author, clinician, political writer, lay person or philosopher has
given to conditions with these traits? Even a pop psychology author or
little-known philosopher is an acceptable answer. If there is more
than one, I will tip up to three times this amount for three
additional answers. However, the person identified must have published
a book addressing the subject, and must have given this phenomena a
name in order to qualify as an answer to this question.

Clarification of Question by dont_look_down-ga on 28 Jul 2003 17:18 PDT
Thanks V, I was looking at your other answers; you are so industrious
and tuned in!

You asked if I was looking for an individual's symptom complex or a
greater societal ill. I am describing a collection of dynamics that I
suppose you could call it a symptom complex, but it includes a number
of social ills that can be active in any given case.

The term I seek is a rubric for medical and psychiatric conditions
that are vulnerable to a set of dynamics, often with disasterous

For example, a person with fibromyalgia suffers from these dynamics.
If the person experiences professional mystification, they will follow
the advice of physicians who have not accurately diagnosed the
condition. If the physicians are affected by capitation/managed care
dynamics, they may see chronic patients as a threat to their
prosperity and their treatment may be contaminated by this, for
example, by not getting adequate assessment or treating the patient in
a way that alienates them. Further, social attitudes about malingering
and productivity may be introjects that impair the patient
psychologically, exacerbating depression and helplessness. Denial may
affect the patient, as she attempts to fulfill social roles, extending
herself beyond her capacities and damaging herself or others.

Above, I turned a short list of biopsychosocial variables into a
personal syndrome that destroyed a patient. Those variables included
professional mystification, corporatization of medicine, limitations
of the medical mindset, denial, situational depression, and cultural
introjects. These forces interact in a reciprocal manner and snowball.
They are lethal.

In this biopsychosocial syndrome, the individual's own psychology, the
attitudes, the beliefs of professionals, culturally ingrained
attitudes, and the policies of institutions are significantly
destructive to the individual.

Key to this is the vulnerability of the patient's specific condition,
such as fibromyalgia, to these dynamics. An example of this
vulnerability is that these conditions are easily misinterpreted for
various reasons. For example, they tend to be outside the scientific
medical mindset or are more diagnostically challenging. Even when
there is a clear empirical measure of the cause, there may be a long
delay before the patient finds a professional who will conduct the
appropriate assessment, if ever. Effort by the patient may help obsure
or mediate symptoms and create an illusion of control compounded by
denial compounded by cultural forces and the need to feel competent.

It is an interplay of conscious and unconscious motives and the
momentum of culture expressed through professions, institutions and

While there is an abundance of references to aspects of this dynamic,
and profound writings about this type of dynamic, I need to learn of
any terms that embrace it. I have found descriptions or phrases, not a

I am especially interested in finding a term pubished in a book for
the general public, rather than academic or clinical, but I really
want to get every term that exists or has been used in a publication,
especially if it has caught on to any degree.

** I will pay the fee for every example that can be found, though,
plus the fee for the information you have already provided. **

Even if there is no term, please add whatever information you feel
would be helpful, and post it >>as an answer.<<

Your comment is very helpful, because I need to read such specialized
expert material about this dynamic so I can do it justice in a piece
I'm writing. I guess you could say you answered a question I would
have asked, had I known the potential of this service.

You have provided wonderful resources about the psychosocial dynamics
that have the impact I'm looking for. I was going to do this research,
but you are already doing it.

I can always revise the question and post it again for others to take
a crack at, so please post your response as an answer.

Of course, social injustice is too broad, and denial is too narrow.
Malingering is a symptom, not the syndrome. Professional mystification
and codependence are dynamics, but are only components of the larger
syndrome I'm describing. Biopsychosocial is a class of dynamics that
include it all, but is way too broad. Fibromyalgia is a condition, but
only one of many that are vulnerable to the dynamics I mentioned.

Systems theory and cybernetic concepts are useful here, and someone
writing on those subjects may have coined such a term.

I hope this helps!

Request for Question Clarification by voila-ga on 28 Jul 2003 22:40 PDT
Yes, thanks for extra info.  If you don't mind, I'd like to grok this
a few more days before posting an answer.  GA is just a part-time gig
for me so I don't have much research time during the week.  I don't
know if you're in any kind of rush for this information, but if you'd
like to post an additional question, you're more than welcome to do
so.  There are quite a few researchers who have an interest in these
concepts and with this additional guidance, I'm sure they'd be glad to
do further research.

This particular question, unless you choose to cancel it, will remain
open until Aug. 18, I'll post anything of additional interest on the
weekends between now then.  Good for you?


Clarification of Question by dont_look_down-ga on 29 Jul 2003 09:28 PDT
Great! I have two projects ahead of this one, so I'm just doing prep
work so I can hit the ground running. Take your time. Thanks so much,
you're fabulous. And thanks for the heads up that other researchers
could work on aspects of this. Enjoy.

Clarification of Question by dont_look_down-ga on 03 Aug 2003 22:28 PDT
Can I say wow?

Thanks for you detailed searching and conceptual expansion. There's
actually a place in this piece for everything you have unearthed, even
philosophical elements from holistic health and eastern thought, since
the people who suffer in these dynamics must deal with so many
stresses to their psyche and energy that are so threatening.
   First you focused a lot on the politics, and now on the economics
and and psychology relating to professional diagnosing and treatment
planning. (And more, of course.)
   As you say, not a lot from pop psych, and you're guessing there
must be much there, and maybe even the elusive NAME for the phenom.
But, unlike Captain Ahab, I'm not sure it's out there. I do know there
are many books for people subjected to the phenomenon, but they
address specific conditions. Sometimes they broaden out, as in the
Indigo Child, or Confessions of a Medical Heretic, or in codependence
literature and so forth. Or on a more macro level, society's problems
germaine to this subject are addressed.
   But this subject is a broad one and demands a lot of integration.
Your efforts are putting wings on this project, as it will be useful
to a number of populations, and help guide professionals as well.
   I'm looking forward to any additional resources you cook up, and
I'm thrilled that you took this on so whole heartedly. I will keep you
up-to-date on the project.
   While the economic and political issues will be important, the
areas that will be most fleshed out will have to do with self care as
a sufferer, including political savvy and understanding the psyche's
of providers, and with thinking through a diagnostic lens that
transcends the in-the-box thinking that sufferers often encounter with
professionals, particularly conservative or burned-out ones.
   Although I'm revealing a lot here, the approach and resources
involved will make the project quite unique.
   Thanks for all your great help!

Request for Question Clarification by voila-ga on 04 Aug 2003 07:07 PDT
Check.  I tend to dive into research projects with hip waders but with
your question probably even more so.  There are so many dynamics
leading up to and impacting this phenom that I don't feel like I've
seized on its nexus yet.

Working at the periphery of healthcare, I must say I've never heard of
a term that fully captures the essence of your definition.  However,
in researching this topic I've added quite bits of jargon  to my
knowledge bank, so I'm not altogether comfortable saying it's NOT out
there.  But if it's THIS
difficult to locate, certainly not enough has been written on the
topic with any specificity.

Needless to say, I've turned this into a bit of a quest for myself. 
I've spoken to several people and intend to speak to a few more before
your question closes.  I also want to cruise a bookstore and see
what's out there and tackle this from a fresh approach.

It makes me smile to know that I've helped put wings on your project. 
I just don't want them to be leaden ones.  While broadening the topic
can sometimes add historical layers and give a multi-leveled
perspective, at some point the vehicle just becomes too weighty to

Consider me drilling down on this term over the next 10 days and
thanks again for the extra markers and sign posts.  I do wish this
venue allowed for direct and confidential contact rather than working
in the somewhat clumsy gloves of Google Answers, but such is not the
case presently.

Will be in touch.

Clarification of Question by dont_look_down-ga on 04 Aug 2003 09:26 PDT
Wow again!

Yes, I understand the "leaden" thing, and fortunately I can boil down
a lot of abstractions into fairly spritely writing that gets
compliments, so the breadth will only help. Thanks so much for the
additional research! I'm glad the additional pointers helped.
    I'll be away to write in the mountains for three days, BTW.
    I'm looking forward to fully digging into this project more than

Request for Question Clarification by voila-ga on 10 Aug 2003 21:59 PDT
Hola DLD,

I discussed the parameters of your term with several people this week.
 No one has ever heard a word that encompasses all the aspects you're
trying to address.  My weekend didn't quite go as expected so I didn't
make it to the bookstore, but I hope to by next weekend.  I'm still
woefully short on anything in the pop psychology department.

In the meantime, here are a few more terms and articles that you prove

Ethics in Managed Care:

Employee Self-Management of Health:

purchaser driven system:
(...) in the provider driven system a sick person generated revenue to
the system; the sicker, the more revenue. In a purchaser driven system
a sick person generates costs, and the changing dynamic of the way in
which that system assesses the risks associated with persons who are
going to place large claims on the health care system is the new
challenge with which we're dealing.

"supermarket medicine"
"interdisciplinary approach"  
'any willing provider' laws 

"physicians' conflict of interest v. quality of care issues" (although
rather long, this is the closest phrase that addresses the co-factors
of the doctor-patient relationship + managed care issue)

I'm sure you're familiar with the "learned helplessness" theory, but I
thought I'd throw the Martin Seligman reference in the mix.
"View that exposure to uncontrollable negative events leads to a
belief in one's inability to control important outcomes, and a
subsequent loss of motivation, indecisiveness with failure to action,
and depression. An individual's passivity and sense of being unable to
act and to control his or her life, acquired through unpleasant
experiences and traumata in which efforts made were ineffective;
according to Seligman, this brings on depression."

Somewhat on the flipside, you might take a look at this book as well:

Validate Your Pain:
Author: Allan F. Chino, Ph.D. & Corrine Dille Davis, M.D.
ISBN#: 0-9708444-9-2
Published Date: 2002

I also checked at the Word Spy website (under "medicine") to see if
any such term had made it into print media yet but I found only two
relateables :
"hit-and-run nursing" 
 An aspect of managed health care in which nurses attend to a greater
number of patients and attempt to speed those patients through the
system by performing tasks—such as drawing blood—previously assigned
to specialists (a.k.a. accelerated-care nursing).

Example Citation:
"They worry that managed care, without restraints, leads to what they
call hit-and-run nursing and to mistakes, abuses and oversights."
—Peter T. Kilborn, "Nurses Put on Fast Forward In Rush for Cost
Efficiency," The New York Times

"nocebo"  (If you wanted to make a case that bedside rationing
constitutes a "nocebo," you may be stretching the intended meaning a
bit, but this term may also work.)

"An inert substance that causes harmful effects because the person
taking the substance expects those effects (cf. placebo)."

Example Citation:
A placebo relieves symptoms of illness by creating an expectation of
improvement, while a nocebo does harm by creating the opposite
expectation, according to epidemiologist Robert A. Hahn of the Centers
for Disease Control and Prevention. Nocebo are not used in medical
research, but nocebo effects are quite common.
—"I Didn't Know That," Los Angeles Times, October 9, 1997

Coincidentally, at Word Spy, I also found a term that fits us
researchers and why we keep pitching for our customers:

"helper's high"  
Feelings of euphoria and increased energy that occur while helping
other people.

I'll see what I can find this coming week and wrap things up next


Clarification of Question by dont_look_down-ga on 11 Aug 2003 13:25 PDT
Giant thanks, again, V!

All this really is required content, isn't it! And thanks for talking
with others, this is priceless. Everything here is making me realize
that, from a mind-mapping point of view, much has been written from
the node of specific condition, patient role, medicine and society,
but not from the node of "condition as vortex" of the stressors and
dynamics involved where the view encompasses the conditions as a
generalization that lends itself to a term. I think this is because it
means creating a new category, which is normally thought of as a
diagnosis and not the job of an academic, journalist or psychologist.
Though it has been done, I know of few examples. I think this (plus
where our culture is in regards to how all this plays out) sums up why
there is no such term that has taken hold in any big way, if there is
any at all. It's all been looked at, just from different nodes in that
universe of dynamics.

Thanks so much for all your effort, and I'm looking forward, as
always, to anything else you have to offer!  - DLD
Subject: Re: Syndrome concept
Answered By: voila-ga on 18 Aug 2003 20:36 PDT
Rated:5 out of 5 stars
Healing the Hardware of the Soul: How Making the Brain-Soul Connection
Can Optimize Your Life, Love, and Spiritual Growth
by Daniel Amen (Author)

Screaming to be Heard: Hormonal Connections Women Suspect, and Doctors
Still Ignore
by Elizabeth Lee Vliet MD, Elizabeth Vliet

10 Essentials of Highly Healthy People
by Walt, M.D. Larimore, Traci Mullins (Contributor), Walter L.

Gary Null's Guide to a Joyful, Healthy Life
by Gary Null, Gary, Ph.D. Null, Gary Who Are You Really Null, Gary Be
Kind to Yourself Null, Gary Choosing Joy Null

Sick and Tired of Feeling Sick and Tired: Living with Invisible
Chronic Illness, Second Edition
by Paul J. Donoghue, Mary Elizabeth Siegel

Fibromyalgia: A Leading Expert's Guide to Understanding and Getting
Relief from the Pain That Won't Go Away
by Don L. Goldenberg

The War on Pain
by Scott Fishman (Author), Lisa Berger (Author)

Fibromyalgia and the MindBodySpirit Connection : 7 Steps for Living a
Healthy Life with Widespread Muscular Pain and Fatigue
by M.D. William B. Salt II, M.D. Edwin H. Season

Why We Hurt: The Natural History of Pain
by Frank T. Vertosick Jr.

When the Air Hits Your Brain
by Frank, Jr Vertosick, Frank T., Jr. Vertosick

All About Fibromyalgia
by Daniel J. Wallace, Janice Brock Wallace

Making Sense of Fibromyalgia
by Daniel J. Wallace, Janice Brock Wallace

Fibromyalgia: A Comprehensive Approach What You Can Do About Chronic
Pain and Fatigue
by Miryam Ehrlich Williamson, Miryan Ehrlich Williamson, David A. Nye,
R. Paul Amand

Alternative Treatments for Fibromyalgia & Chronic Fatigue Syndrome:
Insights from Practitioners and Patients
by Mari Skelly, Andrea Helm, Paul B. Brown

Fibromyalgia and Chronic Myofascial Pain: A Survival Manual (2nd
by Devin J. Starlanyl, Mary Ellen Copeland

The Fibromyalgia Relief Handbook
by Chet Cunningham

Dr. Judith Orloff's Guide to Intuitive Healing: Five Steps to
Physical, Emotional, and Sexual Wellness
by Judith Orloff, Dean Ornish

Phew, down to to wire on this or what?  A pleasure helping you with
this project although the term you were looking for never revealed

Best wishes,
dont_look_down-ga rated this answer:5 out of 5 stars and gave an additional tip of: $10.00
Great researcher. She put so much work of value in her comments on a
very difficult, broad question. She was gracious in starting off with
comments to see if I would accept an answer from her. I asked her to
proceed, and she provided many valuable terms, resources and
references in many key areas necessary to address the subject. This is
all of great value in helping me finish my project in a well-rounded
way. She obviously had a sincere personal investment in the subject,
and looking at her track record, I see she only takes on projects that
she cares about and has a handle on. She's a real pro.

Subject: Re: Syndrome concept
From: pinkfreud-ga on 20 Jul 2003 12:03 PDT
The term "masking" is sometimes used in describing behaviors that
serve to disguise mental illness or substance abuse problems. At one
time, I was a volunteer for an organization that assisted anorexics
and bulimics, whose ability to conceal their illness can be
considerable. "Masking" was a term often used by the psychiatrist who
was our consultant.

Substance abuse expert Dr Patrick Carnes uses "masking" as one of the
criteria for diagnosing Addiction Interaction Disorder:

"Dr. Patrick Carnes discusses how addictions do not just co-exist but
how they interact and reinforce each other. This is called 'Addiction
Interaction Disorder' and there are criteria that can be used to
indicate that clients have a problem involving the interaction of
their addictions.

Dr. Carnes reviews the ten criteria that are used to identify
Addiction Interaction Disorder. The criteria are: Cross-Tolerance,
Withdrawal Mediation, Replacement, Alternating Addiction Cycles,
Masking, Ritualizing, Intensification, Numbing, Disinhibiting and
Subject: Re: Syndrome concept
From: voila-ga on 27 Jul 2003 15:21 PDT
Hello DLD,

I think we might be able to give you a satisfactory answer to your 
question, but I'm a bit confused if you're looking for an individual's
symptom complex or a larger societal ill.  If you would be so kind as
further delineate your needs so we don't go too far off course and
flood you with too much information.

I suppose in the medical model vernacular, these diagnoses might be 
considered "underdiagnosed," "underreported," or "underrecognized" as
borne out in the text here: (redirect)

"Although polls indicate that the majority of Americans view 
alcoholism as a disease, physicians may think otherwise. During a 1997
conference of the International Doctors of Alcoholics Anonymous, a 
physician survey revealed that 80% of responding physicians believed 
that alcoholism stemmed from poor behavior (Hobbs, 1998).

(...) contends that many physicians harbor negative attitudes against
alcoholics. (...) citing empirical data states that many 
non-psychiatrists view alcoholism as the sole providence of 
psychiatrists. However, alcoholism should not be viewed as a character
flaw or lack of will. Instead, alcoholism should be recognized for 
what it is -- a biopsychosocial disease with a strong genetic 
component and clear symptoms, which is fatal if not treated.


Perhaps due in part to prevailing negative attitudes, alcoholism has 
gone largely underrecognized and underdiagnosed in the medical 
community. Research suggests that over 90% of physicians miss 
alcohol-related diagnoses upon initial examination (Gitlow, 2001). 
Physicians often fail to diagnose alcohol abuse despite the fact that
20% of all general practice patients report problem alcohol 
consumption (Fleming, 1997; Fleming, 1998). Research revealed that 
although 12-30% of their patients screened positive for alcoholism, 
many healthcare providers fail to treat the problem as a formal 
disease (Moore, 1989)."


If you're considering only diagnoses that fall into George Engel's 
biopsychosocial model, which
encompasses the biological, psychological, and the social health of a
patient, a phrase you might consider is "sick role behavior."  Talcott
Parsons coined this term back in the 1950s.


Institute for the Study of  Healthcare Organizations & Transactions

"As its very name suggests, the Institute is especially interested in
studying how various stakeholders in the healthcare system relate to 
each other, and how the behavior of each stakeholder is affected by 
the presence and activities of the others."


"But health behavior goes beyond the behavior of individual consumers,
and includes the interpersonal, social and cultural levels of

The behaviors of significant others, family members, friends, 
employers, and co-workers is also relevant to what the individual does
to maintain health and treat disease.

The behavior of healthcare providers is also relevant, both with 
respect to their interactions with patients and their interactions 
with each other, both within and between professions.

And so are the organizations in which healthcare transactions occur. 
Hospitals and clinics, professional societies, regulatory agencies, 
and insurance carriers all play an active role in determining what 
healthcare services are provided, to whom, for how long, how treatment
will be evaluated, and who will pay the bill."

An author I'd certainly include on your list is Arthur Kleinman:  (redirect)

If you could signal if we're in the ballpark with our interpretations
of your question, I think it's entirely answerable.

Best regards,
Subject: Re: Syndrome concept
From: voila-ga on 03 Aug 2003 17:59 PDT
Hello again DLD,

I went a bit 'round the bend once again as I got lost in this juicy
piece of research.  Hopefully these links are not too overwhelming but
feeling like I've just scratched the surface, I'd like to do some
extra followup next weekend and then will post as my final answer.

The research is a bit light on the pop psychology references and, good
golly, I'm sure they're out there.  I'm never satisfied until I look
under every metaphorical rock for your information.  This weekend's
research is primarily focused on a cross-section of physicians'
decision making processes/biases/attitudes and aspects of managed

(includes physicians, nurse practitioners/nurses,
physician assistants, psychiatrists/psychologists

Somatoform Disorder:

Chronic Fatigue Syndrome:  Overcoming the Attitudinal Impasse

"Heuristics are rules of thumb people follow in order to make
judgements quickly and efficiently. People use judgemental heuristics
to deal with the large amount of social information with which we are

Illusory Correlation:
"Another type of judgmental heuristic is known as illusory
correlation, or the process by which people conclude that A and B
belong together." (i.e., fibromyalgia + psychiatric disorder)

Critical Paths 
"Essential steps in the diagnosis and treatment of a condition or the
performance of a condition. They document a standard pattern of care
to be followed for each patient and are developed primarily as a
nursing tool specific to a healthcare organization and its unique
system.  Synonyms for Care Paths: critical paths, practice
guidelines/parameters, clinical guidelines/protocols/algorithms, care
tracks, care maps, care process models, case care coordination,
collaborative case management plans, collaborative care tracks,
collaborative paths, coordinated care, minimum standards, patient
pathways, quality assurance triggers, reference guidelines, service
strategies, recovery routes, target tracks, standards of care,
standard treatment guidelines, total quality management, key
processes, anticipated recovery paths (Lumsdon and Hagland, 1993)."

Negative Bias
"Criteria from the original CFS case definition and biases in the
scoring and selection of psychiatric tests contributed to high levels
of psychiatric comorbidity with CFS. These findings might have
contributed to physician beliefs that CFS was a predominantly
psychiatric rather than medical disorder. In addition, flawed
epidemiologic research significantly underestimated the community
"true prevalence" of CFS. Relying on physician referrals for
generating cases failed to take into consideration the negative bias
of many physicians, and fewer referrals would be generated from those
physicians who were skeptical of the existence of this illness.

Gender Bias in Pain Amplification Disorders:
"If you're in health care you should be asking yourself, 'What biases
do I hold personally about how men and women respond to pain? Does it
influence my judgment?' " When providers become aware of stereotypes
they hold about women, Dr. Unruh adds, men benefit, too: "If women are
more likely to get psychological explanations for their pain, one
might think that's primarily a problem for women," she says. "But all
pain is a psychological experience. With women we pay attention to the
emotional component. With men, we may respond to that not nearly as
well, if at all."

Cognitive Shortcuts:
"These results are not a sign of physician bias toward individuals
with psychiatric histories, (...)  Rather, the findings suggest that
survey participants were probably using "cognitive shortcuts" to
determine disease probability, in this case by taking previous medical
history into account."

Social Cognition: 
"Focuses on the way in which our thoughts are affected by the
immediate social context, and in turn how our thoughts affect social
behaviour. The approach can be summarized as follows:  people take
cognitive shortcuts such as stereotyping in order to minimize the
cognitive load and we develop schemata that represent our knowledge
about ourselves, others and our roles in the social world. Once
formed, schemas bias our judgment schemata become more complex and
organized over time and are harder to change.

Overconfidence, Hindsight, Base Rate Neglect:
Journal of Advanced Nursing
Volume 43 Issue 3 Page 230  - August 2003
"This paper's starting point is the recognition that, for the vast
majority of day-to-day clinical decision-making situations, the
'evidence' for decision-making is experiential knowledge. Moreover,
reliance on this knowledge base means that nurses must use cognitive
shortcuts or heuristics for handling information when making
decisions. These heuristics encourage systematic biases in
decision-makers and deviations from the normative rules of 'good'

Aims. The aim of the paper is to explore three common heuristics and
the biases that arise when handling complex information in clinical
decision-making (overconfidence, hindsight and base rate neglect) and,
in response to these biases, to illustrate some simple techniques for
reducing the negative influence of heuristics."

Bedside Rationing:

Cognitive Tunnel Vision/Micawberism:
"cognitive tunnel vision -- where new data are coerced to fit a
pre-existing and incorrect view of the situation
micawberism' -- believing that everything will work out OK in the end,
despite all the contra-indications"

"Cookbook" Medicine:

Iatrogenic Diagnostic Algorithms:
Postgrad Med. 1997 Aug;102(2):161-2, 165-6, 171-2 passim.  Related
Articles, Links
Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic
algorithms. Do some labels escalate illness in vulnerable patients?
Hadler NM.
"Contemporary medicine has the sophistication to identify the clinical
settings in which the hunt for a diagnosis can be harmful to a
patient's health. Which patients are best served by a prolonged search
for a cause? Why has the disease-illness paradigm backfired for so
many patients? Dr Hadler challenges readers to look at the difficult
questions linked with diagnostic labels that might teach patients to
stay sick." (redirect from Pub Med)

Health Services Research:
"Health services research is the multidisciplinary field of scientific
investigation that studies how social factors, financing systems,
organizational structures and processes, health technologies, and
personal behaviors affect access to health care, the quality and cost
of health care, and ultimately our health and well-being. Its research
domains are individuals, families, organizations, institutions,
communities, and populations."


Adverse Selection:  
(also see "favorable selection," sometimes known as "cherry picking")
"Adverse selection occurs when a larger proportion of persons with
poorer health status enroll in specific plans or insurance options,
while a larger proportion of persons with better health status enroll
in other plans or insurance options. Plans with a subpopulation with
higher than average costs are adversely selected. Plans with a
subpopulation with lower than average costs are favorably selected."

Capitation: (Cap, Capped, Capitate, Base Capitation) 
"Specified amount paid periodically to health provider for a group of
specified health services, regardless of quantity rendered.   (...) 
The method of payment in which the provider is paid a fixed amount for
each person served no matter what the actual number or nature of
services delivered. (...) Providers are not reimbursed for services
that exceed the allotted amount. The rate may be fixed for all members
or it can be adjusted for the age and gender of the member, based on
actuarial projections of medical utilization."

"Practice of excluding specific services from a managed care
organization's capitated rate.  (...) Common carve outs include such
services as psychiatric, rehab, chemical dependency and ambulatory
services. Increasingly, oncology and cardiac services are being carved

Chronic Care 
"Long term care of individuals with longstanding, persistent diseases
or conditions. It includes care specific to the problem as well as
other measures to encourage self-care, to promote health, and to
prevent loss of function."

Health Care Decision Counseling: 
"Services sometimes provided by insurance companies or employers, that
help individuals weigh the benefits, risks and costs of medical tests
and treatments. Unlike case management, health care decision
counseling is non-judgmental. The goal of health care decision
counseling is to help individuals make more informed choices about
their health and medical care needs, and to help them make decisions
that are right for the individual's unique set of circumstances."

Medical Informatics 
"Medical informatics is the systematic study, or science, of the
identification, collection, storage, communication, retrieval, and
analysis of data about medical care services to improve decisions made
by physicians and managers of health care organizations."

Ombudsperson or Ombudsman: 
"A person within a managed care organization or a person outside of
the health care system (such as an appointee of the state) who is
designated to receive and investigate complaints from beneficiaries
about quality of care, inability to access care, discrimination, and
other problems that beneficiaries may experience with their managed
care organization. This individual often functions as the
beneficiary's advocate in pursuing grievances or complaints about
denials of care or inappropriate care."

Peer Review 
"The mechanism used by the medical staff to evaluate the quality of
total health care provided by the Managed Care Organization. The
evaluation covers how well services are performed by all health
personnel and how appropriate the services are to meet the patients'
needs. (...)  Some consumers suspect that peer review is not true peer
review since both the providers and the reviewers often have personal
financial incentives to reduce or increase medical care.  Nonetheless,
peer review is utilized in all managed care settings."

*Review of A-Z terms in managed care glossary:


National Committee for Quality Assurance

Holistic Approach to ADD:

Interesting Stats 101:
"The cost of administering the plan varies from one HMO to another
with some plans showing administrative costs of over 30%. In the US,
physicians account for 14% of the health care dollar, pharmacy expense
19%, hospitals 42%. As recently reported in The Lancet, the chiefs of
seven large HMOs averaged $7 million each in cash and stock pay
packages per year. The average plan, averaging 15% administrative
overhead, therefore, uses much more of its income to pay
administrators than to pay physicians."

Improving Communication with Your Doctor: (example)


Heuristics and Biases : The Psychology of Intuitive Judgment 
by Thomas Gilovich (Editor), Dale Griffin (Editor), Daniel Kahneman

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to
Face Stress, Pain, and Illness
by Jon Kabat-Zinn, Thich Nhat Hanh (Preface), Joan Borysenko

by Ellen J. Langer

Brief Therapy:
Lasting Impressions

Making Medical Spending Decisions
The Law, Ethics, and Economics of Rationing Mechanisms
Mark A. Hall

Crank me up or down, DLD, and feel free to get a second take on this
question.  Consider me off the clock though; I just think whatever
you're up to is important work and I'm happy to contribute.

Your eveready researcher,
Subject: Re: Syndrome concept
From: voila-ga on 20 Aug 2003 08:08 PDT
Thanks for the kind words, rating, and tip on my answer although I'm
not completely satisfied with it.  I was nabbed for an overtime
project this weekend so I didn't make it to the bookstore until late
Monday evening after work.  Checking in the medical reference,
medicine, women's health, alternative health, self-help, psychology,
and philosophy sections, I tried to select books with relevancy from
credentialed authors.  The clerks were shooing me out of the store
while I was checking the bibliography in Dr. Vliet's book which seemed
to address the pitfalls of the doctor-patient relationship across
disease lines.  "Screaming to Be Heard" definitely bears a second

Personal investment?  Sure, I suppose that's true.  GA researchers
tend to be either generalists or specialists.  I prefer to stay in my
area of expertise.  Since none of us get rich from research, a lot of
us turn to it out of passionate curiosity or just plain fun.  Your
question had elements of both and seemed a worthy pursuit.  I wish it
had been a more fruitful one.

I read fairly extensively in this field, so if I come across anything
of interest, I'll post it as a comment.  In the meantime, I'm calling
it "white coat mercenary amnesia" until I unearth something better.

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