On a View of Undiagnosed Distress

Arch Intern Med. 1968;122(3):276-278. doi:10.1001/archinte.1968.00300080084017.
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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.


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