Lal Mira. Clinical Psychosomatic Obstetrics and Gynaecology. A Patient-centred Biopsychosocial Practice

Oxford University Press, 2017. — 373 p. — ISBN: 978-0-19-874954-7.The principles of promoting human health through advancing knowledge are ethically driven. By following these precepts, this medical textbook intends to provide suitable knowledge to manage diseases resulting from mind–body or psychosomatic interactions. It starts by providing the scientific basis of psychosomatic interaction in disease causation, followed by its clinical application for managing related women’s diseases. The field of these diseases is wide-ranging, starting from preconception and extending into the menopause, and also includes the transgenerational aspects of psychosomatic ill-health during a stressful pregnancy that may affect the fetus. The chapters in this book pertain to both emergency and routine management of clinically significant psychosomatic conditions related to physical, psychological, and social determinants of health.
My clinical experience of working in hospitals in the UK confirmed a desperate need, and provided me with the impetus to produce this book to fill a gap in the relevant aspects of medical education. During my training in obstetrics and gynaecology, I had increasingly recognised that many patients did not fall within the commonly practised medical model that holds physical factors solely accountable for all disease manifestations. Patients who did not fit the usual model presented with diverse physical symptoms that could represent every plausible obstetric and gynaecological health condition encountered, but the effects of concomitant psychosocial factors that modified the presenting symptomatology were ignored by attending medical staff. This often led to continuing biopsychosocial symptoms in these patients, whose physicians only attributed blame for their symptomatology to physical factors. Such patients returned repeatedly to seek further healthcare for symptom relief because of the unsatisfactory results of previous inadequate management. They often felt reassured when they were evaluated by the occasional physician who practised a psychosomatic approach in consultations; such management, which ended in symptom relief and patient satisfaction, advanced my learning of biopsychosocial management. Time and again it was brought home to me that when physicians missed the psychosocial aspect, their management had led to patient dissatisfaction, with repeat hospital attendances. Consequently, this was bound to impact on the health facility’s finite resources. I realised that a medical textbook encompassing these disease conditions would aid in the further understanding of such conditions, and improve the care of these patients.
By increasing the physician’s knowledge of psychosomatic interaction and associated biopsychosocial factors, appropriate management could be provided, and repeat hospital/clinic attendances by patients minimised. This would also promote ethical healthcare, as misdiagnosis, and consequent harm from providing the wrong treatment, would be avoided. My intention to gain further knowledge prompted me to carry out doctoral studies, which assessed quantitatively a large sample of women with gynaecological problems after their first childbirth. My study confirmed that there were biopsychosocial needs of these mothers even one year after delivery that were missed by the prevailing healthcare provision. Although presentations and publications followed, I also learnt of resistance in some quarters where the concomitant psychosocial aspect was considered unimportant. Despite being under-recognised by medical personnel, many patients considered the biopsychosocial aspect as being of significance in relieving symptoms and effecting cure. Limited understanding of psychosomatic interactions in managing patients with symptoms due to such pathology led to a persisting morbidity that could be grievous. This was reflected in the UK’s Maternal Mortality reports for the last four triennia, where a lack of recognition of such aetiology led to severe morbidity, sometimes ending in maternal demise. I started to impart such knowledge about the biological, psychological, and social aspects of women’s health by organising teaching sessions regarding clinical psychosomatic interfaces at scientific meetings in the UK and overseas, but wider dissemination was needed. When practicing a patient-centred approach with individualised care, it was obligatory to pay attention to physical, mental, and social health. Although the subspecialty of Psychosomatic Obstetrics and Gynaecology had been practiced in the rest of Western Europe and Japan, since the twentieth century, less attention had been given to it in the UK, thus a need to propagate this aspect for improving women’s health existed. As Chair of the British Society of Psychosomatic Obstetrics, Gynaecology, and Andrology, I approached officials of the Royal College of Obstetricians and Gynaecologists to modify existing viewpoints; it is now recognised in the UK as a subspecialty. However, there was a dearth of textbooks in the English language that interested physicians/postgraduates could follow if they chose to practice this subspecialty. Seeing the global need for such a medical textbook to facilitate effective patient care, I decided to produce this first volume of Clinical Psychosomatic Obstetrics and Gynaecology under the aegis of Oxford University Press. Contributions from experts in the UK, along with international experts were invited. I am grateful to the co-authors from these countries, who have provided chapters to this volume; we have thus been able to reflect all clinical facets of psychosomatic women’s diseases.