Further, it has been repetitively demonstrated that a small proportion of patients utilize a disproportionately large percentage of medical care services. Although some of these high utilizers have serious or significantly severe chronic disease many high utilizers have abnormal illness behavior that is remarkably stable year to year and consume a significant proportion of medical care costs.
Primary care remains the de facto major mental health care delivery system.
This form of somatization has been labeled by Katon and colleagues as the culturally sanctioned idiom of psychosocial distress. Failure by the physician to recognize somatization results in inappropriate and ineffective treatment of the underlying psychosocial problems as well as the ordering of expensive diagnostic procedures or even employment of unnecessary surgical interventions. There are many reasons that a patient may prefer-entially interpret psychosocial distress in terms of physical symptoms. Although the overall management of somatization is best handled by the primary care physician, psychiatric referral is at times necessary. At times, such as with manipulative, drug seeking patients, acceptance of a psychiatric referral may be a condition of continuing involvement with the primary care physician.