[The expertise situation as pathoplastic factor]

Underlying attitudes of apprehension or desire have an essential pathoplastic function, especially in the situation of medical assessment. The functionality of symptoms and complaints requires a diagnostic approach which is not oriented simply towards the "exclusion of organic causes". Interaction between somatogenic and psychogenic factors is by far more common than sheer functionality. Although widely neglected in our medical teaching and literature, these problems are not confined to the mere assessment of temporary or permanent invalidity, but are of great importance for the entire medical sphere, including manifestations and course of a disease, therapeutic success etc. In Austria, the population of foreign workers is in a special position due to socio-economic preconditions, partly due to short-sighted policy devoid of psycho-hygienic considerations. This situation requires thorough analysis free of emotions, which should lead to the development of sensible, although in some respects belated, measures. The latest economical recession has revealed several faulty courses of development in our system of social and health insurance, which needs revision urgently lest it should collapse. In this respect, the medical profession is called upon to contribute to a necessary curtailment of excessive misuse within a system that has become inflexible during the past decades, thereby endangering the valuable achievements of social medicine.