In Reply. —
Dr Nesbitt's first comment reflects a common misconception regarding patients seen in a military medical center. In fact, the demo-graphics and case mix of our patient population is similar to that seen in civilian practice.1 Lack of co-payment makes our system similar to many other prepaid and managed care systems, and I am unaware of evidence that shows such systems promote unnecessary or inappropriate visits.I am particularly chagrined by the tendency to dismiss the complaints of patients in whom physical examination and laboratory tests prove unrevealing. Most individuals suffering from chronic fatigue, unexplained dizziness, sexual dysfunction, persistent pain, or sleepless nights would be offended by having their symptoms labeled as "minor vicissitudes" or "inconveniences." Symptoms can produce functional impairment comparable to major medical illnesses.2,3 We go to great efforts to "medicalize" asymptomatic risk factors, such as hypertension and hyperlipidemia, yet only a minority of
Kroenke K. Let's Not Overmedicalize-Reply. Arch Intern Med. 1991;151(6):1238. doi:10.1001/archinte.1991.00400060143037
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