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Somatization Reconsidered
Incorporating the Patient's Experience of Illness
Ronald M. Epstein, MD;
Timothy E. Quill, MD;
Ian R. McWhinney, MD
Arch Intern Med. 1999;159:215-222.
The large and heterogeneous group of patients with "unexplained somatic symptoms," with or without coexisting psychiatric, "functional," or "organic" illnesses, provides continuing difficulty for clinicians. The construct of somatization artificially separates bodily and psychological symptoms that patients experience as a unified whole. Concurrent chronic illnesses make it difficult to exclude "general medical conditions." The diagnosis requires that the patient seek medical care. Conflict between patients' experiences of illness and physicians' diagnostic categories, and fear of blaming the patient, complicate naming and characterizing the illness. We recommend an approach to clinical care that involves exploring the patient's life context, finding mutually meaningful language to arrive at a name for the illness, normalizing the patient's bodily experience of distress, using a chronic disease model that attends to functioning, and addressing the physician's need for certainty and efficacy. Health systems can help coordinate care and avoid iatrogenic harm by appropriately controlling access to medical services.
From the Primary Care Institute, Highland Hospital (Dr Epstein), Program for Biopsychosocial Studies and the Departments of Family Medicine (Dr Epstein), Internal Medicine (Dr Quill), and Psychiatry (Drs Epstein and Quill), University of Rochester School of Medicine and Dentistry, and the Department of Medicine, The Genesee Hospital (Dr Quill), Rochester, NY; Institut d'Estudis de la Salut, Barcelona, Spain (Dr Epstein); and Centre for Studies in Family Medicine, University of Western Ontario, London (Dr McWhinney). Dr Epstein is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.
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