Francesco Carelli 

Professor of Family Medicine, Milan, Rome, Cluj

It’s generally accepted , as in the European Definition of Family Medicine, family doctors don’t take care only of illness, but also consider patients in holistic way. Because of this, we meet everyday functional patients, i.e. without an identifiable organic cause of disease.

Family doctors mitigate uneasiness and this convinces patients to undergo a medical visit. Pain, discomfort and other symptoms provoke uneasiness and worries that interfere with normal activity or could overcome normal threshold of subjective tolerability.  The physician is before diseases that are often somatic expressions   of troubles of state of mind with no organic component.   Everyday family medicine uses reassurance, participation, encouragement. Medical practice is not to cut or to cure or a manual job, but must be felt from the heart, full of compassion and endowed with the gift of acute observation.

Functional trouble can be defined as any derangement of an organ in which there is no apparent degeneration, damage, impairment or structural change. Dorland’s illustrated medical dictionary defines as trouble that interests the function but not structure; Churchill’s illustrated medical dictionary defines as a disorder without organic note cause; Roche Lexicon Medizin defines as contrary of organic.

If we try to reassume these definitions, we realize that the prominent element of a functional trouble is a state of uneasiness that does not present any anatomical alteration, it doesn’t allow to apply any explanation cause-effect, if by any chance to have recourse to psychological interpretations, these last are more interpreted than verified.  But functional trouble, although it presupposes a psychological genesis, it cannot surely be confused with a psychosomatic trouble, that is a physical disorder that originates or is increased by psychic or emotional processes, not being to be confused with diseases with certain psychiatric diagnosis’s dignity  For such reasons we could define the functional troubles like a ring of union between psychic important troubles and organic troubles tout court.

Because there is not privileged center, each organ and apparatus could present itself dysfunctional and the medical more commonly implicated areas are: orthopedical, gastroenterological, gynecological , urological, neurological.  In the neurological apparatus we could suffer migraine, headache. Cardiovascular apparatus could give precordial pain. Gastrointestinal apparatus could give nausea, vomit, abdominal pains,  air swallowing, dyspeptic symptoms,  syndrome of the irritable bowel.  Urogenital apparatus could give menstrual troubles, urine retention, dyspareunia, anorgasmy, impotence, frigidity, delayed ejaculation. Osteomuscular apparatus could give muscular tension, headache, myodynia, low back pain.

We can say that the state of alarm induced on health by media, the conditions of economic crisis or uncertainty, the fall of self evaluation are exaggerating the application of treatments, inducing false needs and a small awareness of the real state of health are increasing functional troubles. The recognition of such must induce, after adequate diagnostic screening, to contain this expressive form of individual uneasiness through a relationship of reassurance and to favor for better self consciousness, reducing so incongruous demands by users of family medicine’s practices.