The problem patient. Evaluation and care of medical patients with psychosocial disturbances.

The physician often finds that certain patients are poorly responsive to usual methods of therapy, especially those with somatic symptoms in whom psychosocial factors are a major, if not the sole, determinant of the illness. To care for such patients one must understand their illness as the product of mutually interacting biologic, psychologic, and sociologic determinants. Guidelines for evaluation and treatment using this more comprehensive approach are presented.