One of the most difficult problems for the internist is to deal with the patient who complains of a disturbing symptom complex, the exact basis for which cannot be accurately described. This is a common problem, and it is most likely that as long as the internist wishes to serve as a consultant for the primary practice community, he will be asked to see a large share of such patients. The question that arises is how best to manage the problem.
The story is a familiar one. The patient has a vaguely-localized pain or is light-headed or is easily fatigued, and the initial evaluations by the primary physician do not quickly define the illness. There sometimes may be a whole series of disturbing symptoms, none of which clearly relate one to the other. A specific syndrome does not emerge; the discomforts persist; and so the patient seeks a comprehensive evaluation.