Problems That Bring People to Primary Care
The ten most common problems brought to adult primary medical care are: chest pain, fatigue, dizziness, headache, swelling, back pain, shortness of breath, insomnia, abdominal pain, and numbness. These ten complaints account for 40% of all visits. The doctor can identify a biological cause for the complaint in only 15% of these visits and in only 26% of all visits that are driven by a specific complaint. The vast majority of patients coming to primary care have no discoverable organic disease. (Kroenke, K. & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy and outcome. American Journal of Medicine, 86, 262-266.)
In fact, Wayne Katon, MD, one of the leading researchers studying the relation of mental and physical disorders in primary care, says, “I think mental health practitioners often believe that the somatizing patient is a rare phenomenon. In fact, to the primary care physician, the “psychologizing” patient is the rare phenomenon because people with psychological distress present the majority of the time with unexplained physical symptoms such as headaches or backaches”. (Katon, W., Lin, E., von Korff, M., Russo, J., Lipscomb, P., Bush, T. (1991). Somatization: a spectrum of severity. American Journal of Psychiatry, 148, 34-40).
The majority of the diagnosable mental health and substance abuse disorders present in primary care and get whatever treatment they get there. The primary medical system has been characterized as the nation’s de facto mental health system. (Regier, D., Narrow, W., Rae, D., Manderscheid, R., Locke, B., & Goodwin, F. (1993). The de facto mental health and addictive disorders service system. Archives of General Psychiatry, 50, 85-94.)
And lastly, the protocols for treatment of most chronic illnesses include behavioral health interventions such as weight loss, smoking cessation, healthy eating, and exercise