Consultation Letter

It has been shown that writing a consultation letter to assist other physicians or health care providers improves the health of patients with somatization disorder (Smith et al., 1986), abridged somatization disorder (Smith et al., 1995), and multisomatoform disorder (Dickinson et al., 2003) and also reduces costs. The recommendations in the consultation letter improve outcomes for somatic patients, as well as making these patients seem less burdensome and difficult for clinicians. The consultation letter should include the following:

• Notification of physician or other health care provider that the patient meets criteria for somatization.

• Reassuring information about the nonlethal prognosis of somatization.

• Encouragement to schedule the patient for regular, brief visits, rather than waiting for the patient to develop a new symptom or schedule an urgent visit.

• Recommendation to follow all complaints with a focused physical examination and generally to pursue workups only if physical findings are present.

• To avoid hospitalization, surgery, and subspecialty referral, if possible.

• To view the symptoms as part of an unconscious process, and to avoid telling the patient, "It's all in your head."

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