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van der Maas PJ. Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure. Am J Public Health 1994;84:20-8. 5 McMurray J, Hart W. The economic impact of heart failure on the UK National Health Service. Eur Heart J 1993;14(suppl) were perceived by patients as tangible, exculpating, and involving. These explanations were experienced by patients as satisfying and empowering. Conclusions Patients with somatisation disorders feel satisfied and empowered by medical explanations that are tangible, exculpating, and involving. Empowering explanations could improve these patients' wellbeing and help to reduce the high demands they make on health services.

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For primary care patients with a new episode of LBP referred by their GP, prompt access to a dedicated physiotherapy service is both feasible and acceptable. Comparison with other published interventions suggests that it is also cost-effective and that a typical Primary Care Trust (PCT) would rapidly recoup the cost of additional physiotherapists. However, questions remain about the availability of sufficient physiotherapists to make such a service available nationally. The influence of the service upon GPs' own approach to the management of LBP is likely to be gradual and to come about largely through positive feedback from patients.

In this sample of primary care patients with persistent unexplained physical symptoms, we found little evidence of discrete somatic syndromes. The level of health care use is no indication of mental state or level of disability, and the findings are equally consistent with depression or anxiety being secondary to disability and its consequences as with them being primary. The observed collaboration between patients and their doctors carries the risk of shaping, reinforcing, and legitimizing dubious syndromes.