Somatoform and related disorders: delivery of diagnosis as first step.

The care of patients with diagnoses on the somatoform spectrum represents a challenge to all primary care physicians and is a matter of frustration to some. These patients tend to "doctor shop," and studies indicate that they generate health care costs that are at least six to 14 times higher than health care costs generated by control subjects. For all disorders on the somatoform spectrum, the most effective management is regular follow-up with the primary care physician. To accomplish this goal, a therapeutic delivery of the diagnosis to the patient is essential to firmly establish the therapeutic alliance. An approach is suggested for "administering" the diagnosis as the first step in treatment for patients with several types of somatoform and related disorders. These techniques allow the patient's emotional needs to be met, enable the patient to save face when necessary and solidify the doctor-patient relationship. A good relationship allows the physician to provide long-term management with empathetic, safe and cost-effective medical care. Physicians may at times dread somatic patients, and these useful techniques can help them begin a more satisfying relationship with their very challenging patients.