The referral process

As previously mentioned, the patients with somatization disorder are often resistant to psychiatric referral as they believe they have a physical and not a psychological problem. They may construe the referral as a sign that the physicians are not taking their symptoms seriously. It is important that the referring physicians avoid giving the message that the patients are not genuinely ill, that they trouble the doctors unnecessarily, or they are 'mad'. (37> A close liaison with medical colleagues guiding them in making a psychiatric referral in an acceptable way is important for engaging the patient in treatment.

Feedback to the referring doctor of the psychiatric examination results must be made in a way that is intelligible to a doctor who may not be psychologically minded. Statements like 'No formal psychiatric disorders are found' may be of little help to a patient referred for medically unexplained symptoms.

The psychiatrist must be careful not to become involved in criticism of medical colleagues, and in the divisions these patients often invoke between different therapists.

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