At the Medicine Grand Rounds held in March 1997, Dr Arthur Barsky discussed
the management of multiple somatic complaints in a 37-year-old man who is
self-employed.1 Mr H began to experience multiple
physical complaints during adolescence. Since that time he has visited doctors
frequently for a wide variety of symptoms accompanied by intense anxiety and,
at times, mild depression. His doctors, including Dr Y, a medical resident,
felt the complaints were primarily psychosomatic in origin, and multiple medical
evaluations failed to reveal significant organic findings. Dr Barsky discussed
the epidemiology and mechanisms of symptom formation in patients like Mr H,
focusing on "care, rather than cure," and outlining an approach to management
that frequently proves worthwhile to the patient and clinician. We asked the
patient and his doctor to comment on the year that has passed.
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