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Minor acute illness: a preliminary research report on the "worried well".

OBJECTIVES
Our objectives were to determine how patients who make frequent use of the medical system (high users) with medically unexplained symptoms met our chart-rating criteria for somatization and minor acute illness and what the stability of such diagnoses were over time.


STUDY DESIGN
A chart review was performed at baseline and 1 and 2 years; we re-rated the charts of patients initially rated as having somatization, as well as a 15% sample of those with minor acute illness.


POPULATION
We obtained a random sample of high-use patients (= 6 visits/year) aged 21 to 55 years who were identified from the management information system.


OUTCOMES
We measured chart review designations as organic disease, somatization, or minor acute illness.


RESULTS
Among 883 high users at baseline, 35% had organic diseases; 14% had somatization; and 51% had minor acute illness as their primary problems. No patients with initial minor acute diagnoses were reclassified as having somatization 1 or 2 years later, and all but 2 patients had minor acute illness in 1 or both follow-up years.


CONCLUSIONS
Minor acute illness was more common among high users than somatization and organic diseases combined. It has not previously been studied but probably has been recognized by clinicians as the "worried well." Diagnoses of somatization were unstable over 2 years follow-up, while minor acute diagnoses were stable, supporting the latter as a valid entity.