Excluding organic disease

A small minority of 'somatizing' patients referred to psychiatrists have a genuine physical illness that has been missed. The initial evaluation should therefore always include making sure, preferably by personal discussion with the referring doctor, that appropriate physical assessments have been done. Some psychiatrists favour carrying out a physical examination themselves. If no evidence of organic disease is found, the patient should be firmly reassured at the outset, but repeated reassurance is unhelpful. Following this, the psychiatrist often contracts with the patient that any requests for more sophisticated tests and second opinions should be addressed to the referring doctor, as patients may otherwise use this as a means of avoiding underlying psychological issues.

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