II. Management: Set realistic goals

  1. Focus on function, not on symptoms
  2. Symptoms may not resolve completely
    1. Does not need to be frustrating
    2. Does not warrant a new battery of tests
  3. Help a patient cope with symptoms
  4. Successful treatment criteria
    1. Minimize hospital admissions and emergency visits
    2. Minimize potentially harmful interventions

III. Management: Treat comorbid medical conditions

  1. Intersperse routine health examinations
  2. Guide treatment with objective exam findings

IV. Management: Frequent diagnostic testing is not needed

  1. Reassure patient that they are healthy
  2. Frequent visits will identify any serious problems
  3. Negotiate lab tests as needed

V. Management: Avoid Opioid Analgesics

  1. Use Tylenol or NSAIDs as needed
  2. Emphasize Narcotic adverse effects
    1. Constipation
    2. Sedation
    3. Addictive potential
  3. Narcotics do not cure somatizer's need to be sick
  4. If Narcotics are needed
    1. Contract for low, fixed Narcotic doses
    2. Use slow onset, long acting Narcotics

VI. Management: Minimize frequent phone calls

  1. Emphasize that frequent calls are very time consuming
  2. Share physician's feelings and expectations
  3. Set limits (e.g. 2 ten minute calls between visits)

VII. Management: Reduce Frequent Emergency Department Visits

  1. ER care is counter-productive to somatoform management
    1. Inconsistent care
    2. Aggressive evaluation implies serious illness
    3. Potential for iatrogenic complications
  2. Develop joint plan with Emergency Department
    1. Avoid repeating lab tests or hospital admission
    2. Evaluation indicated for new objective findings
  3. Establish understanding with patient
    1. Regular clinic visits serve all medical needs
    2. Consider more frequent clinic visits

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