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To the Editor.—Dr Barsky's discussion on somatization disorder¹ raises several important points, and the format permits insight into the dynamics of the patient-physician relationship. The importance of this bond has been seen as the essence of the management of this syndrome for centuries. Socrates stated, "The great error of our day in the treatment of patients is that men try to be physicians to health and temperament separately."² In 1983, Monson and Smith³ corroborated the points raised: development of a long-term empathic relationship, validation of distress, listening and careful examination, the importance of appropriate regular follow-up, and perhaps most important, avoidance of diagnostic or therapeutic enthusiasm capable of inflicting harm.

I have found several additional management strategies to be helpful. First, I attempt to ascertain which of the multiple symptoms are most troublesome, so as to diminish the symptom "noise level" and allow the patient to focus on improvement. . . . [Full Text of this Article]

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RELATED ARTICLE

A 37-Year-Old Man With Multiple Somatic Complaints
Arthur J. Barsky
JAMA. 1997;278(8):673-679.
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