Reading 7 C Texts

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions
7-22, choose the answer (A, B, C or D) which you think fits best according to the text.
Text 1: Psychology and allergy As a clinical psychologist, I’m very familiar with the concept of
‘Them and Us’, the idea that in order for me to be okay, to have what I need, I have to keep
others – them – out. It’s not an uncommon belief in society. Interestingly, this definition also
almost perfectly defines allergy. When the body - Us - mistakenly identifies foreign food
proteins - Them - as dangerous, it launches an excessive, possibly cataclysmic, defence. Of
course, that food will usually become part of Us once eaten and digested, but in cases when
the body sees it as a threat, it is most certainly Them. Them and Us confusion also causes
other immune system diseases such as autoimmune arthritis where the body mistakes
connective tissue for a threat and attacks it, resulting in terrible joint pain.
You may be wondering why a psychologist would be interested in allergies. There are actually
a few good reasons, but basically, in terms of allergies in general, during the middle part of the
twentieth century, we often viewed the condition as a psychosomatic illness, a physical
manifestation of psychological problems. In the case of asthma, the asthmogenic, or asthma-
producing, home, often featuring a stereotype smothering, overbearing parent, was often
seen as the cause of childhood asthma, to the extent that so-called ‘parentectomies’ – the
separation of the child from its parents – were suggested as a possible cure.
Also at that time, the relationship between mental illness and food allergy symptoms was
similarly complicated, and controversial. Food allergists and their critics clashed frequently. On
the one hand, many prominent food allergists stressed that food allergy could trigger mental
disturbances, ranging from depressive and psychotic episodes to hyperactivity in children. The
solution to many a person’s mental illness, they argued, was a thorough elimination diet to
determine the food that was at fault. Food allergy critics however – and there were many of
them – argued the very opposite: the symptoms of food allergy were nothing more than the
physical manifestations of psychological problems. So-called food allergy sufferers, they
argued, would benefit more from the counsel of a good psychiatrist, rather than an
unscrupulous food allergist, who would merely encourage their delusions.
As in many instances of medical controversy, it now seems likely that neither the allergists nor
their critics were completely right, nor completely wrong. While food, and especially food
chemicals, are most probably the cause of mental disturbances in some sensitive individuals,
and particularly children, the intensity of an allergic reaction can certainly be exacerbated by
heightened levels of stress. There is most certainly a psychological component not only to
allergy, but also to many other aspects of our immune system.
But after I gave a talk on allergy at another conference recently, it became clear that there was
also another psychological aspect to the subject. As I stepped down from the podium, a crowd
of people quickly assembled in front of me, asking all manner of, well, fairly personal questions
about their, frankly surprising, range of food allergies. Now, while I always provide the
disclaimer that I am not a medical doctor, I quite enjoy hearing the stories people have to tell,
which are often very poignant. And sometimes I feel I can give a small amount of advice, if it is
only to suggest that a second opinion is sought. In this particular instance, I could tell that
many of the people asking me questions had not received a great deal of sympathy from their
doctors and simply wanted someone to talk to. It was as if I was the first person with the word
doctor in front of their name who was willing to listen. and I felt the beginnings of a real
connection. But time is not always on the side of the listener. After about ten minutes, I
needed to move aside for the next speaker. On the stairs outside of the auditorium, however,
the fascinating conversations continued until I had to be hauled away from them because I’d
promised to give a media interview.
What struck me was that there was something missing in the relationship these people had
with their various physicians. Dealing with disturbing, unexplained symptoms, many food
allergy sufferers feel isolated. This is terribly unfortunate, but it does help to explain why often
completely unqualified food allergists have been so successful in attracting patients, despite
their often eccentric theories. For one thing, they listened to their patients. Not only that, they
also had to rely on their patients’ testimony and experiences to diagnose their allergies. The
relationship between food allergists and patient was more of a partnership, with each party
playing an essential role. Some psychiatrists might even learn something from this approach.
Text 2: Chronic pain

You sometimes hear it said that physicians in the USA have a rather negative attitude towards
chronic pain. If so, it’s an attitude that is already evident in medical school. The literature
supports the notion that undergraduate medical students are concerned about treating
patients with chronic pain. A qualitative study found that many viewed chronic pain as the
condition it was most difficult to deal with. The failure to teach undergraduates appropriate
bio-psychosocial chronic-pain management skills is consistent with the finding that pre-clinical
relationship skills curricula aren’t well co-ordinated. Of this disconnect, Giordano and Boswell
astutely noted, ‘So, while mechanisms of pain and analgesia are taught during basic
neuroscience courses, there is no direct link to how the complexities of these systems are
relevant to the illness of chronic pain and challenges of chronic-pain management’.
Inadequate training of primary-care providers is certainly not a new phenomenon. Early in the
history of the discipline of pain medicine in 1976, John Bonica called for increased education
about pain in all health-sciences schools. There was a minimal response to this call. Then, in
2000, the American Academy of Pain Medicine (AAPM) issued a position statement, calling
upon medical schools to increase required curricular content in chronic pain, palliative care,
and end-of-life care, but this, too, had little influence on medical school curricula as far as we
can determine.
In their 2011 study, Mezei and Murinson found that a number of American medical schools
didn’t report any teaching of pain whatsoever, with many requiring five or fewer hours of such
education. The authors concluded ‘that pain education for North American medical students is
limited, variable, and often fragmentary’. In 2005, the International Association for the Study
of Pain published its Core Curriculum for Professional Education in Pain. The report of the First
National Pain Summit also called for better education about pain, as did the Core
Competencies for Pain Management report and the Institute of Medicine (IOM) report. Little
happened to medical education in response to these guidelines and reports. As reported by
Briggs and colleagues, ‘… the amount of hours of pain education in the undergraduate
curricula is woefully inadequate given the burden of pain in the general population’.
Most medical schools utilise a biomedical model and focus on knowledge-based learning,
often ignoring students’ emotional development and reflective capacity, both of which are
necessary to deal with pain patients effectively. A recent study in which board members of the
AAPM rank-ordered ideal objectives of medical student pain education yielded not only
examination and prescribing skills but also compassionate care/empathy and communication
as the top four of twenty-eight topics identified.

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Part C

Text 2: Chronic pain

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