No subject

one who can be characterized as a "distressed high utilizer of medical
services" ) is likely to suffer from unrecognized psychiatric or
psychosocial disorders,  particularly depression, dysthymic


appropriate.Assess for potential personality disorders. 
Effective treatment of a patient with a suspected or confirmed
personality disorder will require a team approach, including a mental
health care provider. Patients with these disorders rarely respond
well to the diagnosis; be sure to describe the disorder in
non-accusatory terms. Treatment progress may be slow.Consider a
possible systems problem. Time restraints that make thorough
consultations problematic may be sapping you of satisfaction in your
practice of medicine.  If possible, adapt your scheduling to
allow more time for difficult patients--but do not hesitate to set
limits. Patients who abuse office staff, insist on immediate telephone
access to the health care provider, or generally encumber the process
of care will require negotiation. "In order for me to be able to take
good care of you," you might say, "I will need your help. Are you
willing to make some changes in how you use our services?"Acknowledge

they have told you. Understanding how serious the patient believes the
condition to be can spare you both undue frustration.
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