A 37-Year-Old Man With Multiple Somatic Complaints

DrDelbanco: Mr H is a 37-year-old man who has had multiple physical complaints for years without a clear medical diagnosis. An immigrant from Colombia to the United States, he is selfemployed, and works as an educator for the young in the inner city. He is covered by a commercial managed care insurance plan and is cared for by a medical resident in primary care practice at the Beth Israel Deaconess Medical Center. His multiple physical complaints began during adolescence with nausea and vomiting without weight change In recent years, he has suffered from periodic pruritus ani, legs that become weak at times, and allergic symptoms including hay fever, allergy to cats, and recurrent itchiness around the eyes. He notes a frequent rectal discharge and had 1 episode of bleeding, evaluated by colonoscopy, which was normal. Liver function tests were mildly elevated in the past. He has experienced pain and numbness