SOMATIZATION AND MEDICALIZATION IN THE ERA OF MANAGED CARE
SOMATIZATION AND MEDICALIZATION IN THE ERA OF MANAGED CARE
复制标题
DOI：
10.1001/jama.274.24.1931
复制
发表时间：
1995-12-27
影响因子：
120.7
通讯作者：
BORUS, JF
中科院分区：
文献类型：
--
作者：
BARSKY, AJ;BORUS, JF
由于社会文化潮流降低了公众对轻微症状和良性疾病的容忍度，降低了因此类投诉寻求医疗照顾的门槛，报告的躯体化，即没有病理生理学解释的躯体症状似乎正在增加。这些趋势与身体痛苦的逐步医学化相吻合，在这种医学化中，不舒服的身体状态和孤立的症状被重新归类为疾病，并寻求医学治疗。躯体化和医疗化在管理式医疗时代可能会变得更成问题。在按人头收费的情况下，医疗服务提供者将有更大的动力减少使用，而躯体化患者可能会感到被迫以更紧急和夸张的方式表达他们的“不适”，以便获得医生的帮助。此外，预付费用户几乎不会因经济原因而不愿为相对较轻的疾病就医;因此，他们可能会增加对医生咨询的需求。这种情况表明，迫切需要改善躯体化患者的管理。创新的咨询，行为和教育干预措施现在可用。此外，医疗专业人员应该相当谨慎地迎接医疗化的过程，并教育公众更多地了解健康人的症状和身体不适的规范性存在。需要进一步研究躯体化及其与医疗需求的关系。在一个管理式护理的时代，应更加重视理解和控制护理需求，其中很大一部分是症状驱动的。
Somatization, the reporting of somatic symptoms that have no pathophysiological explanation, appears to be increasing as sociocultural currents reduce the public's tolerance of mild symptoms and benign infirmities and lower the threshold for seeking medical attention for such complaints. These trends coincide with a progressive medicalization of physical distress in which uncomfortable bodily states and isolated symptoms are reclassified as diseases fdr which medical treatment is sought. Somatization and medicalization are likely to become more problematic in the era of managed care. Under capitation, providers will have greater incentives to reduce utilization, and somatizing patients may feel forced to express their ''dis-ease'' in more urgent and exaggerated terms in order to gain access to the physician. in addition, prepaid subscribers will suffer little financial disincentive to seek medical attention for relatively minor complaints; therefore, they are likely to increase the demand for physician consultation. This situation suggests an urgent need to improve the management of somatizing patients. Innovative consultative, behavioral, and educational interventions are now available. In addition, medical professionals should greet the process of medicalization with considerable caution and educate the public more about the normative presence of symptoms and bodily distress in healthy people. Additional research is needed into somatization and its relationship to the demand for medical care. In an era of managed care, increased attention should be devoted to understanding and controlling the demand for care, a large portion of which is symptom driven.