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July 1986

To the Editor.—

Author Affiliations

Northampton, Mass

Arch Intern Med. 1986;146(7):1448. doi:10.1001/archinte.1986.00360190240039

—In the January 1986 issue of the Archives, Smith et al1 presented data obtained from a group of patients with somatization disorder. In a recent paper,2 we described one of our patients who had incurred $46,000 in medical charges in a single year, and whose estimated lifetime medical bills totaled one-half million dollars. We documented that this 39-year-old patient had undergone at least 82 operative and invasive diagnostic procedures, as well as 54 admissions and 66 emergency room visits at eight separate hospitals. Having experienced the incredibly time-consuming work involved in tracing the patient's medical care, and having unsuccessfully attempted to forestall yet another surgery, we would like to comment on Smith and co-workers' study.

We appreciate the Promethean labor involved in gathering data on 41 patients, but question the methodology. Smith and co-workers performed formal interviews, calculated health care charges, and had their subjects complete the Rand

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