The psychosomatic approach in the practice of medicine.

The psychosomatic approach requires of the practitioner broad knowledge and skills relevant to the psychosocial, metabolic and physical responses of patients. The approach, being holistic, becomes appropriate in many different clinical situations (and should not be restricted to a few so-called psychosomatic diseases). Wise physicians and perceptive laymen have recognized the validity of an holosomatic approach for over 4000 years. Although the prevalence and incidence of psychosomatic disturbances are difficult to estimate (and probably underestimated in many surveys), data support the statement that family physicians should employ a psychosomatic approach in at least 15 per cent of cases. The general internist will probably encounter primarily psychosomatic disturbances in about 30 per cent of his patients; for example, many common presenting symptoms such as fatigue and chest pain arise in a setting of psychological stress. Apart from a sound knowledge of the genesis and manifestations of metabolic and structural changes, the physician must be familiar with the causes and symptoms of psychological disorders. Skillful interviewing and histroy-taking provide the data necessary to analyze and unravel psychosomatic interplay. Psychotherapeutic interviews often enable both the patient and the physician to understand the clinical problem: this understanding appears to aid recovery.