[The problem patient in dermatological practice. Psychomatic aspects (author's transl)].

In an exemplary case (44 year old female patient with pruritus) the priority of somatic aspects of an "organized disease" is questioned. The conception of a "total diagnosis" on the basis of a "pluriperspective complementary medicine" taking into consideration genetic, anatomic, physiologic, biochemical, microbiological, psychological and sociocultural facts is presented as the antithesis. Besides a somatic diagnosis the aim of medical procedure is the recognition ("reference diagnosis") of a "reference disturbance" in the doctor-patient relationship in which the "fundamental disturbance" of the patient is recalled from early childhood. This reference diagnosis can be learned by dermatologists and general practitioners in Balint groups.