[Somatoform pain disorder--contradiction between medicine and jurisdiction? The physician's point of view].

Swiss court rulings are based on the assumption that people suffering from chronic somatoform pain disorders and fibromyalgia usually remain fit for work. Exceptions are granted if predetermined medical criteria are met and documented. In this way jurisdiction has decisively infringed on medical matters. Courts use criteria originating from medical publications by K. Foerster which they have modified and balanced in a rather peculiar way. The prognostic criteria of K. Foerster have never been validated scientifically, and courts do not use them according to the intentions of the author Jurisdiction is too strongly guided by diagnoses. Diagnoses correlate poorly with the extent of disability. In court rulings psychiatric co-morbidity is given an importance which cannot be derived from the medical literature. Today there are specific rulings for specific diagnoses, encouraging patients and insurers to embark on legal battles for favourable diagnoses. In chronic psychosocially influenced disorders and linear causative understanding of disease processes jurisdiction relies on an outdated medical basis. At present medical and legal reasoning are strongly interlocked. From a medical point of view these planes of consideration need to be disentangled.