Characteristics of patient–doctor relationships with somatizing patients

Patients who somatize are perhaps the most difficult challenge for the primary care physician. Physicians who are trained essentially in the biomedical model feel ill-equipped to diagnose, manage or treat these patients. In some practices, they may constitute more than 50% of the physician's burden. They also have been shown (by Katon, R. Smith, and others) to be excessively high utilizers of all medical services, including hospitalization. Because physician and patient bring discordant expectations to the clinical encounter, frustration is fostered on both sides of the patient–doctor equation, the outcome is unsatisfactory, and both participants search for ways to deal with their ensuing anger. This presentation will discuss the dynamics of such encounters, report on a pilot study of patient and doctor expectations and the way they affect communication, and will outline guidelines for physicians to more effectively and therapeutically manage the somatizing patient.