Sir William Osler noted succinctly: "A patient with a written list of symptoms-neurasthenia."1 Jackson et al2 have provided objective confirmation of his observation in their study of predictors of mental disorders in a primary care setting. As a physician in such a practice, I found their results helpful in providing a better understanding of those patients who are often described pejoratively (but, perhaps accurately) as "a positive review of systems" or "heartsink patients."3 Armed with such an understanding, these patients become less an emotional and intellectual challenge and, instead, present an opportunity to provide truly beneficial care. Unfortunately, such patients, like those with somatization disorder, are often reluctant to accept that a mental disease exists.4 Nevertheless, unneccesary testing can be avoided and a more appropriate dignostic and therapeutic approach can be followed once such patients are recognized using the clinical cues identified by Jackson and colleagues.
Sutton SK. Osler on the "Positive Review of Systems" Patient. Arch Intern Med. 2001;161(21):2631. doi:
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