Patients with symptoms and signs referable to nervous systems place special requirement on the physician's approach.The most immediate task is to consider whether the symptoms are merely the nonspecific signals of a systemic disorder or refelect intrinsic neurologic disease.Pain,headache, nausea, dizziness,fatigue,and weakness all lack specificity until taken in context with the rest of the history and physical findings;as often as not ,such symptoms can reflect the emotional ravages of disturbed psychologic adjustment.To understand and treat human beings a doctor needs to know who is sick as mush as or more often than what is sick.Put it in Peabody 'words:"The secret of the care of the patient is careing for the patient.
A second major consideration is to realize that although all are to some degree frightened of illness,concern over the possible of paralysis,server pain, or mental impairment instills an especial terror which requires the doctor's attention and reassurance. When examining such patients,if at all possible,Osler's dictum should be followed:"Do the thing and do it first."
What is stress? Despite the popularity and common image of the term “stress” ，there is actually considerable confusion about its exact meaning. In the lay usage, stress has come to be associated with life events that are thought of as annoying, distressful, or harmful. Terms such as conflict , threat, anxiety, or thrill are often used synonymously.
The perception of and adaptation to events that are “stressful” play a crucial role in determining whether, in fact, they are a negative force on an indivdual. “Ball players, soldiers, sailors and many others look on stress with such exuberance that their hormonal and neural responses must be different from those of the more sedentary who might look with anxiety or loathing on the same activity.
An early and generally accepted definition of stress by Hans Selye is that it is the nonspecific response of the organism to any demand placed on it.
From an engineering point of view, stress produces strain, and many scientists use the term in the same sense. In this conceptualization, stress is used to describe the individual’s response to provoking agents know as stressors. Stressors can be divided into long-term and short-term, depending on the time period over which they act. A more useful division is into environmental and psychological stressors. Environmental rapid would include external factors such as noise, vibration, electric shock, sudden rapid moment, temperature extremes, etc. Psychological or emotional stressors include such things as fear and anxiety.
The National Conference on Emotional Stress and Heart Disease has offered a contemporary definition of stress: ”An obviously pain or adverse force which induces distress or strains upon the emotional and physical make-up.”
It is apparent that stress is highly individual totality of constitutional factors, including heredity, early growth and development, psychological conditional throughout life, cultural factors, and morale or group support. It is through this web of interlocking mediating force that a potential “stressor” must pass. Every individual will thus respond in a unique way to a potentially provoking event. It has been noted that what may be stress producing in some individuals may be enjoyable in others.
We begin aging at the moment of conception and continue to age until we die. But old age, the time of life that nineteen-century British prime minister Benjamin Disraeli labeled “a regret”, is as often feared as it is misunderstood. Children who eagerly count the days from one birthday to the next may grow into adults who dread the passage of the years. Yet the visible presence of many politicians, judges, artists, writers, businesspeople, homeworkers, and other healthy, active, and creative individuals in their seventies, eighties, and even nineties proves that old age need not be synonymous with senility and idleness.
Indeed, far from being a burden to themselves and society, the aged may often be better citizens than their young counterparts. They are more likely to observe laws, participate in the political process, and volunteer their services to charitable and religious organizations. Older workers perform as well as or better than younger workers in most jobs and have less turnover, fewer on-the-job accidents, and less absenteeism. Contrary to stereotype, older drivers have safer driving records than those under 65. Although not all of the elderly are financially secure, most have their economic needs met through Social Security, other pensions, and Medicare and are eligible for many programs and services at reduced rates. The aged are usually free from the day-to-day responsibility of child care and full-time jobs, and thus, health permitting, are able to enjoy leisure time, travel, and the company of friends.
