The first step to a productive interaction is to identify the underlying reasons for the frequent visits.
It is important to refrain from suggesting that “it's all in your head,” and avoid the cycle of vigorous diagnostic testing and referrals.
A strategy for communicating with a new somatizing patient who has “doctor-shopped” might be to address the issue directly at the beginning of the encounter.
As many as 15 percent of patient-physician encounters are rated as “difficult” by the physicians involved.1 Patient characteristics that suggest the likelihood of difficult encounters include the presence of depressive or anxiety disorders, more somatic symptoms and greater symptom severity, according to the study.
Not all difficult encounters can be blamed on the patient side of the interaction.
Physician attitudes about care, fatigue, stress and burnout can create circumstances in which physicians are responsible for the difficulties.