The authors' emphasis on less restrictive diagnostic criteria for somatoform disorders than that used for somatization disorder is in keeping with current opinion in primary care. The second point to emphasize is the importance of developing empathy for these patients. We know that they suffer, and understanding some of the psychologic or cultural stresses in their lives allows us to see their suffering in a context we can understand. If we can understand and know our patients, we often can offer more effective treatment. Also, understanding that patients may be unaware of their effect on physicians is a useful tool for developing the empathy necessary to care for them.
Some physicians find that working in teams can be helpful.
Because psychodynamic and cognitive-behavioral psychotherapies can be effective for somatizing patients, having a good therapist available to the team can be helpful for the patient and supportive for the family physician. Balint group work 8 is specifically geared toward understanding the use of the physician-patient relationship in troublesome interactions such as these. Even referral to a colleague for a short break may be a legitimate alternative. Caring for ourselves allows us the energy to give the compassionate care these patients deserve. Katherine L. Margo, M.D., is associate residency director of the Harrisburg Family Practice Residency Program and medical director of the Harrisburg Family Practice Center.