Professor Louise Stone Professor at the Adelaide Medical School and Associate Professor in the school of medicine and psychology at the Australian National University , Canberra , ACT .

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This information was correct at the time of publication : 14 February 2025

BACKGROUND

THERE is a moment in the life of

a patient who is seriously ill when they realise that a cure is not possible . This moment can be profoundly destabilising , and for many of our patients , it occurs in hospital where there may be few resources to help them cope in an overstretched health system .

To survive in this world , most of us carry a sense of security and safety by placing our trust in important institutions and people . If I become seriously ill , we reason , the tertiary hospital with its expensive technology will fix my pain , the doctors will rescue me and the pharmaceutical industry will supply me with a cure . There is a horror when we realise that these institutions have limits , and we can be , in fact , profoundly alone in our suffering . As one of the author ’ s patients put it “ We all walk close to the edge of a cliff as human beings . We are all vulnerable . It ’ s just that now I notice the cliff is there , and I can ’ t help looking down ,” see figure 1 .

People who are aware of their own deep vulnerability feel profoundly unsafe and isolated . Most people believe , however unconsciously , in

the just-world hypothesis , the idea that life is inherently fair . In this world view , good people deserve their good fortune , and therefore are protected from illness through their own healthy behaviours . This world view can be shattered when they or their loved ones become sick . There are social consequences for the person who is ill . It means many people will avoid them , because seeing a ‘ good ’ person who is sick makes them feel vulnerable . Others will blame the sick person for their own illness .

Ill people often experience shifts in their social connections . People they expect to support them may disappear from their view , unable to tolerate the vicarious trauma of visiting someone who is very unwell . This is particularly painful when the person who is suffering is a child . Others will be ‘ remedy offerers ’, producing a stream of options to cure the illness . When the sick person has already adjusted to the chronicity of their illness , remedy offerers are at the least , irritating , and at worst , a source of criticism , judgement and shame .

For some people with deep spiritual beliefs around healing , there can be a sense of betrayal and

isolation if they are unable to achieve wellness through spiritual practices . For these people , chronic illness can isolate them from their community , who may either see them as an uncomfortable reminder of the limits of healing , or assume they deserve their suffering .

As GPs , we need to assist our patients with coping , not only with their physical suffering , but also with the psychosocial consequences and profound shifts in their identity . We are witnesses to suffering and can tolerate it . Our role is often to remind the patient of their strengths when their confidence and skills disintegrate in the wake of trauma , and to help them form new narratives of being in the world when they are no longer the person they used to be .

This How to Treat explores each of the four coping strategies in detail and discusses how GPs can support their patients ’ existing strategies and introduce additional options to improve recovery .

WHAT IS COPING ?

COPING has a natural trajectory

( see figure 2 ). With acute stress , there is usually a rapid deterioration

in coping skills for around three days , and then a gradual recovery . 1 In general practice , it is common for patients to take bad news well , although they may not remember much of what has been explained in the first consultation .

However , there is a deterioration in function for a few days . This means normally capable people may struggle to eat , wash , dress and make appointments . For this reason , it is always wise to see people around day three , to make sure they are managing . Practice nurses can be very helpful in this scenario , checking in the following day and where there are no accessible carers or family members , arranging appointments and referrals . By three months , most patients and their families will have adjusted . Even in palliative care , it is normal to see most patients and families regain their previous levels of function after around three months , a process the author often considers to be ‘ psychosocial homeostasis ’.

During the first three months , and during the long tail of trauma that follows it for those with chronic conditions , GPs often need to assist