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Physical symptoms
account for over half of all outpatient encounters, or an estimated
400 million clinic visits in the United States alone each year(Schappert,
1992). To see the frequency of specific symptoms as the principal
reason for seeking health care, click on Table 1 below.
At least one-third
of physical symptoms lack an adequate medical explanation even
after diagnostic work-ups. This substantial proportion of unexplained
symptoms has been well established in at least 5 studies conducted
in the general medical setting (Kroenke,
2003) and has recently been shown to be the case for
subspecialty clinics as well (Reid
et al., 2001).
Physical symptoms,
particularly those that are poorly explained, cause suffering
and disability, high health care utilization and costs, diagnostic
and therapeutic frustration, and patient as well as provider dissatisfaction.
As a result
of the high toll associated with these symptoms our principal
objectives in this chapter are:
- To address
practical issues in investigating symptoms that are relevant
to the symptoms researcher as well as the practicing clinician.
In particular, measurement issues will be exemplified.
- To demonstrate
how, as broadly defined, somatization is one essential aspect
of symptom presentation and evaluation.
Rather than
addressing these two objectives separately, we will approach them
in an integrated fashion through a series of problems and examples.
The principles covered will be of generic importance, regardless
of the specific symptom or patient population one is studying.
A more detailed
review of symptom research can be found in a special issue of
the Annals of Internal Medicine, volume 134, number 9 (part 2),
pages 801-930, which was published 1 May 2001 and entitled: "Investigating
Symptoms: Frontiers in Primary Care Research".
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