Dr. Weinberg, thank you for the comment that the "central tool of our trade is listening to the patient's story." Dr. Koven's essay suggests that listening to the patient's story is more than taking a thorough history; it is also a willingness to explore the psychosocial factors that may be contributing to a patient's illness. In contrast, some physicians argue that the psychosocial aspects of illness belong to psychiatry or social work, and that other specialities are responsible only for addressing their patients' pathophysiology. Do you or your colleagues share this latter viewpoint? If so, is it the result of not having enough time? What other factors beyond time prevent physicians from "taking the plunge"? If time weren't a factor, should non-psychiatrists be responsible for understanding and addressing the psychological and social factors that contribute to a patient's illness, or is this beyond their scope of practice? At the risk of oversimplifying this complex topic, is the ideal aim of medicine to respond to pathophysiology or to suffering more generally?
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