This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (93)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

One of Medicine's Blind Spots

Timothy E. Quill, MD

JAMA. 1985;254(21):3075-3079.

Abstract
Patients with somatization disorders are frequently unrecognized and misdiagnosed. The diagnosis depends on recognizing a long-standing pattern of seeking medical intervention for vague, multisystemic symptoms, often without clear physical cause. These patients use symptoms as a way to communicate, express emotion, and be taken care of. Instead of recognizing the disorder and exploring psychosocial contributors to illness, nonpsychiatric physicians tend to repeatedly pursue organic possibilities through multiple tests, procedures, medications, and operations. In patients with somatization disorders, the dollar costs of this strategy are only exceeded by its potential for iatrogenic harm. More productive treatment strategies are presented, emphasizing the need for a long-term relationship with a primary care provider who will treat the patient and his symptoms seriously and respectfully but who is not compelled to invasively evaluate all symptoms.

(JAMA 1985;254:3075-3079)

Author Affiliations
From the Division of Internal Medicine, The Genesee Hospital, and the Division of Behavioral and Psychosocial Medicine, University of Rochester, New York.

Footnotes
Reprint requests to Internal Medicine Division, The Genesee Hospital, 224 Alexander St, Rochester, NY 14607 (Dr Quill).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Managing future Gulf War Syndromes: international lessons and new models of care
Engel et al.
Phil Trans R Soc B 2006;361:707-720.
ABSTRACT | FULL TEXT  

Somatization Increases Medical Utilization and Costs Independent of Psychiatric and Medical Comorbidity
Barsky et al.
Arch Gen Psychiatry 2005;62:903-910.
ABSTRACT | FULL TEXT  

"Unexplained" Somatic Symptoms, Functional Syndromes, and Somatization: Do We Need a Paradigm Shift?
Sharpe and Carson
ANN INTERN MED 2001;134:926-930.
ABSTRACT | FULL TEXT  

Somatization Reconsidered: Incorporating the Patient's Experience of Illness
Epstein et al.
Arch Intern Med 1999;159:215-222.
ABSTRACT | FULL TEXT  

Does Geriatric Evaluation and Management Improve the Health Behavior of Older Veterans in Psychological Distress?
O'Donnell and Toseland
J Aging Health 1997;9:473-497.
ABSTRACT  

Impact of Screening for Mental Health Concerns on Health Service Utilization and Functional Status in Primary Care Patients
Reifler et al.
Arch Intern Med 1996;156:2593-2599.
ABSTRACT  

The Primary Care of Patients Who Have Bodily Concerns
Blackwell and De Morgan
Arch Fam Med 1996;5:457-463.
ABSTRACT  

Assessing Beliefs about 'Environmental Illness/Multiple Chemical Sensitivity'
Gomez et al.
J Health Psychol 1996;1:107-123.
ABSTRACT  

Rehabilitation of Patients in Pain
Kanner
Neurorehabil Neural Repair 1991;5:153-160.
ABSTRACT  

Medical Resident Education: A Cross-sectional Study of the Influence of the Ambulatory Preceptor as a Role Model
Quill
Arch Intern Med 1987;147:971-973.
ABSTRACT  

To the Editor.-Reply
Smith and Monson
Arch Intern Med 1986;146:1450-1450.
ABSTRACT