Whether hypochondriasis is treated through educational, cognitive-behavioral, psychopharmacological, or psychodynamic means, clinical experience suggests that all treatments benefit from a salubrious patient-physician relationship. Therefore, I conclude this section with several recommendations to enhance such relationships for the benefit of patients with hypochondriacal complaints and behavioral styles.

1. Avoid the temptation to label patients whose diagnosis and treatment are uncertain.
2. Listen to patients’ complaints with an open mind and a nonconfrontational stance.
3. Do not shortcut thorough history and physical examinations based on warnings from previous physicians.
4. Do not dismiss patients without follow-up; depression and schizophrenia can be fatal.
5. Do not overtreat patients out of fear of missing something organic. Excessive laboratory studies and procedures usually treat only the physician’s anxiety.
6. Use reassurance sparingly and appropriately. One cannot really reassure until one knows what is wrong.
7. Explore the context in which the patient’s symptoms began. Clues to losses, disappointments, helplessness, and isolation may be found.
8. Do not be too quick to translate somatic complaints into psychological explanations.
9. Permit patients sufficient dependence to develop trust and alliance, but encourage enough independence to avoid regression.
10. Do not respond to patients’ wishes to be “rescued” with an air of omnipotence. Promises that cannot be kept will worsen the patients’ conditions.
11. Refer patients to other physicians only when appropriate. Referrals out of frustration only deepen patients’ resentment.
12. Be restrained with the prescription pad. A return appointment is often more productive and meaningful.
13. When patients expand their conversation beyond symptom complaints, they are improving. Do not rush to ask “What happened to the (headache, backache, sore arm, and so on)?”
14. Do not feel timid about setting limits or guilty about charging for time spent even though managed care companies may not yet comprehend the value - both in cost and care - of such maintenance treatment.
15. Curb therapeutic zeal and strengthen commitment to care, which will result in more satisfaction for both patient and physician.

Continuing efforts by the treating physician to comprehend illness behavior, in the presence or absence of organic findings, with prudent use of newer interventions, will nurture improvement in both mental and physical health care.