Patients referred to you with somatic complaints are frustrated that no one understands how they feel. Suggesting a psychological cause for their symptoms often triggers disbelief, resistance, or denial.
Hearing these patient’s feelings affirms that you are not dismissing their concerns. We have found the following 5-step, systematized approach helpful for validating somatic symptoms. Supportive psychotherapy1 also can help patients develop coping mechanisms or recall skills learned elsewhere.
STEP 1
Give patients an opportunity to outline their physical symptoms. Listen to their complaints without interrupting—except for clarification—or offering solutions. Emphasize that all illnesses have a physical basis and ask about prior workups.
STEP 2
Acknowledge how difficult it must be to have these symptoms. Be nonverbally attentive: maintain good eye contact, show concern, display a relaxed posture and demeanor, and give undivided attention. Keep your phone and beeper off or turned down if possible.
STEP 3
Encourage patients to devise solutions, or help them acknowledge ways they have coped with the problem previously. Discuss responses and support the use of constructive strategies.
If patients say nothing has worked for them, ask what they have tried and whether these “trials” were adequate. Some patients, such as those with personality disorders, may naysay suggestions or be unwilling to find solutions. Empathize again with their frustration, and go to step 4.
STEP 4
Present a tentative suggestion, but leave it to patients to implement when they are ready. For example, recommend that a patient complaining of light-headedness get up from bed slowly to decrease dizziness. Ask whether your suggestion sounds reasonable and how difficult it would be to do.
STEP 5
Patients who are not receptive to suggested interventions might inadvertently convey what they want—such as a referral to a specialist or to see you more frequently. Again, start with what patients present as solutions and discuss their feasibility.
Acknowledgment
The authors thank Alan D. Schmetzer, MD, for his contributions to this article.