IN A RECENT paper we discussed the problems of diagnosis and treatment for patients with undifferentiated health aberrations.34 * It was observed that there is a need for the physician to become more flexible in his conception of illness; that the traditional models of disease causation and cure are not always applicable, and that in the case of the problem patient, reliance on such models can lead to vague diagnosis and no sound plan of therapy. Since the ambulatory patient with diffuse vegetative and subacute psychosomatic dysfunctions constitutes a large percentage of patient visits to physicians and clinics, the lack of meaningful diagnoses and treatment has become an area for concern.
The data obtained from studies carried out at the University of Pittsburgh and Heidelberg Medical Clinics readily show that the problem patient is by experience and definition a person who is "stigmatized" by
OTTO von MERING, L. WILLIAM EARLEY. Major Changes in the Western Medical EnvironmentImpact of Changes in Care of Undifferentiated Disorders. Arch Gen Psychiatry. 1965;13(3):195–201. doi:10.1001/archpsyc.1965.01730030001001