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In Reply: In response to Dr Trief, we noted that our study design does not permit us to determine how much of the treatment effect can be attributed specifically to the consultation letter. However, the multidimensional nature of the illness and the wide range of positive outcomes observed make it unlikely that the consultation letter had more than a very modest impact: not only did patients improve across a range of attitudinal, affective, cognitive, and behavioral domains, but their functional status and role impairment improved as well. It is difficult to attribute such widespread effects to a single letter. In addition, a substantial fraction of patients changed primary care physicians during the course of the follow-up interval, further diluting any effect the letter may have had. Finally, such a consultation letter has only been tested in somatization disorder, where its effect has not yet been conclusively established. Moreover, its effectiveness . . . [Full Text of this Article]

Arthur J. Barsky, MD
abarsky@partners.org

David K. Ahern, PhD
Department of Psychiatry
Brigham and Women's Hospital
Boston, Mass

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