Management of Hypochondriacal Patients

In terms of physician frustration, few patients are more difficult to treat than the demanding, fussy, chronic neurotic who confronts his doctor with an endless recital of functional complaints. Symptomatic treatment is often useless or deceptively temporary, and referral to a psychiatrist is resisted. Classic psychotherapeutic techniques, involving lengthy interviews with nondirective methods aimed at giving the patient insight into the emotional causes of his difficulty, are rarely effective. A technique which is more effective, time saving, and well within the abilities of any practicing physician, is a controlled, scheduled program wherein the physician may function more comfortably as a benevolent, but authoritative, person. The goal of such therapy, which is management rather than treatment, recognizes that such patients have established a chronic illness pattern that may be modified but cannot realistically be removed.