1. How often do you see patients with psychosomatic symptoms?

Not often. This is usually a diagnosis of exclusion (meaning we can only arrive to this

diagnosis after we have ruled out all other causes for the patients symptoms.)

2. How many tests do you usually perform before you conclude that the pain is

psychosomatic?

This depends on the patients symptoms. For example, if someone is experiencing

abdominal problems our workup may include imaging, lab tests, and a gastroenterology

consult.

3. How do you tell the patients that there is no physical cause for their pain?

Only after we have done a thorough work up for the patients symptoms.

4. How do patients react to this news?

It all depends on how you present it to the patients. Personally, this is how I approach

these patients. I walk into their room with a lap top and piece of paper. I start off by

going over their presenting symptoms this ensures them that I clearly heard all their

concerns when they presented to the hospital. I pause and ask them Is this correct?,

this confirms that we are both on the same page. I then proceed to take out a piece of

paper and write down all their symptoms and possible causes for their symptoms. This

helps them to understand my thought process. Next to each differential diagnosis I write

the test or imaging that is needed to confirm that particular disease. I pause and ask
 them Are you following me. Do you have any questions? After I have confirmed they

are truly grasping this concept I pull out my lap top and go over all the tests and imaging

I performed. Again, this ensures the patient that all the appropriate measures have been

taken. I pause and allow the patient to absorb everything they have seen and heard.

The most common question I get after I have paused is If all of these tests are negative

what does this mean? How can we explain my symptoms? I always proceed with:

Thats a very good question. I can see your just as confused as Iam. Now there is

another possibility that I think we should explore however, before we talk about this

condition Id like to ask you if your having any current stressors or anxiety in your

personal life? I havent had a patient respond with No I pause and give them time to

collect their thoughts and think about their stressors and I proceed by saying Well,

there is another condition I think we should look into and that is called psychosomatic

disorder and explain to them what this disorder is.

With this approach Ive always had a great response from my patients.

5. What do you recommend to psychosomatic patients?

Psychotherapy

6. How do nurses and doctors typically treat psychosomatic patients? Do they take

them seriously?

Unfortunately, once this diagnosis has been made most doctors and nurses dont take

the patients symptoms seriously.

7. What are the most common symptoms of psychosomatic patients?

I usually encounter patients with neurological or abdominal symptoms.

8. How do you relieve their pain?

Once they are reassured that the correct workup has been done and you come up with

a plan for them (involving psychotherapy) their symptoms start to slowly improve.

9. Is it necessary to take a second opinion or can you usually tell when a patients

symptoms are psychosomatic?

I definitely consult multiple medical specialists prior to making this diagnosis. Again, this

is a diagnosis of exclusion and only after I have taken the appropriate steps and ruled

out all other causes for this condition could I call this psychosomatic disorder.

10. Do you find that most psychosomatic patients come through the ER, STATCare

or do they schedule appointments?

I work in the hospital so the majority of my encounters are through the ER.