P J Wagner1, J E Hendrich. 1. Department of Family Medicine, Medical College of Georgia, Augusta 80912-3500.
Abstract
BACKGROUND: Health care "misusers" have long been identified as hypochondriacs, problem patients, "worried well" patients, and persistent somatizers. The stereotypical pattern includes persistent pursuit of medical care, a wide range of chronic symptoms, and underlying depression. The purpose of this study was to gather prevalence data on individual patients and to examine patient variables that influence the use of medical services by this population. METHODS: Frequent health care users in an HMO were classified by their primary care providers in terms of appropriate use (36%), moderate misuse (inappropriate or psychosomatic, 27%), and extreme misuse (both inappropriate and psychosomatic, 37%) categories. Utilization and diagnostic data were compared using analysis of variance or chi-square tests. RESULTS: All patients rated as misusers to any degree represented only 17.1% of the population, yet accounted for 42.7% of the visits. Extreme misusers accounted for 25% of visits and 10% of the population. Compared with frequent appropriate users, misusers had a greater belief in their own responsibility for health (internal health locus of control), expressed more concern about their mental health, and rated psychological symptoms as more serious. In addition, extreme misusers were younger, reported more symptoms, and believed less in the physician's control of their health. Misusers sought care for minor symptoms or for complaints that were not diagnosed as disease. CONCLUSIONS: Misuse as a physician-perceived variable is highly prevalent. Misusers differ in their beliefs about health care as well as in the kinds and severity of problems for which care is sought. Physicians need to be sensitive to the interpersonal nature of this problem so as not to discourage preventive medical use, and to recognize the value of these visits to the "worried well" population.
BACKGROUND: Health care "misusers" have long been identified as hypochondriacs, problem patients, "worried well" patients, and persistent somatizers. The stereotypical pattern includes persistent pursuit of medical care, a wide range of chronic symptoms, and underlying depression. The purpose of this study was to gather prevalence data on individual patients and to examine patient variables that influence the use of medical services by this population. METHODS: Frequent health care users in an HMO were classified by their primary care providers in terms of appropriate use (36%), moderate misuse (inappropriate or psychosomatic, 27%), and extreme misuse (both inappropriate and psychosomatic, 37%) categories. Utilization and diagnostic data were compared using analysis of variance or chi-square tests. RESULTS: All patients rated as misusers to any degree represented only 17.1% of the population, yet accounted for 42.7% of the visits. Extreme misusers accounted for 25% of visits and 10% of the population. Compared with frequent appropriate users, misusers had a greater belief in their own responsibility for health (internal health locus of control), expressed more concern about their mental health, and rated psychological symptoms as more serious. In addition, extreme misusers were younger, reported more symptoms, and believed less in the physician's control of their health. Misusers sought care for minor symptoms or for complaints that were not diagnosed as disease. CONCLUSIONS: Misuse as a physician-perceived variable is highly prevalent. Misusers differ in their beliefs about health care as well as in the kinds and severity of problems for which care is sought. Physicians need to be sensitive to the interpersonal nature of this problem so as not to discourage preventive medical use, and to recognize the value of these visits to the "worried well" population.