An adverse side effect of the explosive advances in the basic sciences and medical technology has been the "medical model," in which clinicians exhaustively search for a precise organic disease to explain every symptom while simultaneously discounting the psychosocial factors that contribute substantially to human illness. Because as many as half of the symptoms evaluated in primary care settings cannot be pigeonholed into specific diseases, critics have often argued for the use of a broader biopsychosocial model. The late Allan Barbour, a master clinician-educator in the Stanford Diagnostic Clinic, has distilled 40 years of experience into a book that is both practical and scholarly.

The 18 chapters focus on interviewing, evaluating, and caring for patients with unexplained physical symptoms, functional disorders, and illnesses caused or exacerbated by psychological distress. Although they are epidemic in both primary and subspecialty care, these disorders can trigger feelings of frustration and incompetence in physicians. Barbour offers many pearls that will make the irritable bowel syndrome, chronic fatigue, depression, atypical chest pain, dyspepsia in the absence of ulcer, and other difficult conditions less formidable. He discusses our "remarkable capacity for maneuvering illnesses into medical models ... If all you have is a hammer, you will look for nails to pound." He cautions us about "splitting our patients into minds and bodies, relegating the former to the ‘shrinks,’ the latter to ‘real’ doctors—a schizophrenia of care." The author's criticisms, however, are like gentle incisions and aim to improve rather than overthrow our current paradigm of health care.

The bibliography alone is valuable, consisting of more than 1000 references that range from classic articles and texts to papers published as recently as 1992. Moreover, writings in this field age better than writings in other areas of science; thus, many of the citations will remain timely for decades to come. The hard-nosed epidemiologist demanding randomized clinical trials and meta-analyses will be disappointed: Research in this field draws heavily on the social sciences, receives little funding, and requires a holistic rather than a reductionistic approach.

Listening to patients did not fare well in a fee-for-service environment that rewarded procedures rather than cognitive services, and it will face different but equally challenging economic constraints under capitated systems that encourage briefer and less frequent office visits. Precisely for this reason, clinicians need to be adept in managing the ubiquitous and undifferentiated ailments that will continue to present no matter how health care is financed. This is less a reference book than a book to be read cover to cover by health care providers of all types, in training as well as midway through their careers. Were he alive today, Osler would be pleased to write the preface.