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provides empathy and forms the foundation for effective rapport and a therapeutic alliance to be established. Step II: Elicit patient's perspectives regarding symptoms-this strategy allows focus for examination and for specific reassurance. Step III: Focussed history, physical examination and laboratory investigations-this step is cardinal in excluding medical causes of symptoms, reassuring the patient that such diseases have been excluded and in increasing patient confidence and satisfaction in the consultation. Step IV: Specific reassurance about the absence of serious physical disease while simultaneously acknowledging the reality and distress of the symptoms Step V: Discussing alternative explanations for symptoms for increased patient understanding of the problem. This is very reassuring when symptoms recur or persist. Such explanations can be grouped under (i) the absence of structural abnormality with presence of benign functional disturbance (ii) anxiety, depression and stress causing physical symptoms (Eg. depression lowers the pain threshold) (iii) personality and coping style where people focus on physical symptoms and reduce the importance of psychological factors. Step VI: Prescribing medication. Antidepressant medication can be prescribed if depression and anxiety are present and where pain is incapacitating (Eg. headache, atypical facial pain, irritable bowel syndrome, atypical chest pain, etc). Tricylics are useful when patients also have sleep disturbance while SSRI's for those without. People without anxiety, depression or pain can be given vitamins Step VII: Recommending general psychological measures. Yoga, meditation, regular physical exercise, involvement in religious activities, hobbies and leisure are useful for those under stress. Step VIII: Specific education, discussion of stress and problem solving. Education helps people with sexual misconceptions and dysfunction and those who require advice on contraception. People with difficult social situations benefit from problem-solving skills. Step IX: Discuss the individual's role and responsibility in stress reduction and improved coping. Step X: Offering continued support and planning for regular review of progress is necessary. A gradual shift in focus, from physical symptoms and medication to the management of and coping with the psychosocial context and stress is necessary. Physicians must also be aware of the need for referral and specialist management for those with persistent symptoms, intractable interpersonal difficulties, and patients with classical psychiatric syndromes and substance dependence not responding to adequate therapy in the general medical setting. Such protocols can be employed in busy general hospital settings. There is a need for psychiatrists to appreciate the reality of general medical settings while liaising with physicians. Reply Sir, We …