title: Minor acute illness: a preliminary research report on the "worried well".
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Michigan State University, Dept of Medicine, B312 Clinical Center, 138 Service Rd., East Lansing, MI 48824, USA. smithrr@pilot.msu.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smith
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gardiner
authors.forename: Judith S
authors.initials: JS
authors.lastname: Lyles
authors.forename: Monica
authors.initials: M
authors.lastname: Johnson
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rost
authors.forename: Zhehui
authors.initials: Z
authors.lastname: Luo
authors.forename: John
authors.initials: J
authors.lastname: Goddeeris
authors.forename: Catherine
authors.initials: C
authors.lastname: Lein
authors.forename: C William
authors.initials: CW
authors.lastname: Given
authors.forename: Barbara
authors.initials: B
authors.lastname: Given
mesh_terms: D000328:Adult; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D013001:Somatoform Disorders / Q000453:epidemiology*