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Approach to the Somatizing Patient

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Presentation of a case

A 34 year old female who is employed as a temporary clerk presents with a chronic intermittent history of dizziness and parasthesia. This condition has worsened over the past few weeks. The location of the tingling sensation varies. She also mentions "gas and stomach pain" which is also chronic and intermittent. Even though she has seen many doctors and has had many tests, she states no one can find out what is wrong with her. She wants another opinion. She states that she has been sick a lot since childhood and is on various medications on and off.

Physical examination reveals an over weight woman. She is normotensive. She has diffuse mild abdominal tenderness without true guarding or rebound tenderness.

Neurologic examination is normal. Discussion

This patient has vague non localising symptoms.

She has a pattern of exaggerating and a history of doctor shopping. There is no localizing symptom or sign and multiple work-ups which have probably been done, have all been unproductive.

This patient is probably somatizing. Somatization accounts for upto 30% of all visits to primary care physicians. The symptoms vary from mild to severe and very bothersome to incapacitating. Many of these patients receive unhelpful or iatrogenically dangerous evaluations or treatment that fails to address the underlying problem.

In general, patients go to doctors to feel better and the doctor helps the patient to feel better. In the somatizing patient, rapid and persistent symptoms resolution is unlikely. This leads to patient and physician frustrations.


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