Letter: Coping with pain

Sir: Although John Atkins (letter, 22 February) starts by disagreeing with the views of Jeremy Laurance ("Stoicism might save the NHS", 16 February) he in fact makes the same point - that the relationship between symptoms and attendance at a doctor's surgery is affected by individual differences.

Considerable research has been undertaken to identify the ways that cultural, social, gender and individual differences affect the way that people interpret pain and other physical problems and thus influence decisions to seek professional help. A health system that is aware of this will be more efficient in allocating resources to those with the most need.

For instance, those with a more "vigilant" approach to physical symptoms do worse at the acute phase of illness but are better when more active rehabilitation is required; those patients who are more "passive" are correspondingly better at accepting acute illness but less effective in handling the later stages when more personal responsibility for improvement is required.

CATHERINE DOOLEY

Consultant Clinical Psychologist

East Horsley, Surrey