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 26% of these visits. The vast majority of patients coming to primary care have no discoverable organic disease. This is even more true for low income and underserved populations.
There are plenty of people coming to primary care who have psychological problems. The estimates of how many patients in primary care have a diagnosable psychological disorder vary widely. These numbers are about average for the many estimates:
Most of these people do not consider the physical problems that they bring to primary care to be related to psychological difficulties. People who have a psychological disorder are much more likely than average to bring physical problems without disease (somatizing) to primary care, and people who bring lots of physical problems without disease to primary care are much more likely than average to have a psychological disorder.
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".
Involving a mental health professional with many of these patients can be clinically effective and cost effective, but it is unlikely to be possible unless the service is seen by the patient to be part of their primary medical care.