Introduction: Functional abdominal pain (FAP) in childhood as defined by the Rome II criteria is commonly associated with unrecognised psychological factors and a degree of parent–child enmeshment. We hypothesised that the increasingly consumeristic approach to medicine advocated by governments and medical professional bodies alike might be counterproductive in enmeshed families who lack insight into the origins of their child’s FAP. Methods: 23 consecutive referrals (11M, 12F median age 14 years) of children with FAP to a single gastroenterologist at a tertiary referral centre were studied retrospectively. All had been investigated according to standard clinical service guidelines and a positive diagnosis of FAP made. Predictors of outcome were analysed using Fisher’s exact test Results: 15/23 had already had >2 Consultant opinions and 14/15 were dissatisfied with such opinions. 9/23 were frankly hostile towards the medical profession at first consultation in GOSH. 12/23 had complained about some aspect of their child’s care (9/12 at GOSH) and 8/12 complaints were overt attempts to manipulate some facet of their child’s care (for example further referral or inappropriate investigation). Investigation via the formal Hospital complaints procedure did not find the physician at fault in any instance. In 12/13 of the families who accepted psychological referral there was evidence of family conflict / dysfunction and poor insight into the child’s illness. Poor outcome (defined as pain lasting > 12 months and failure to return to normal levels of functioning) was associated with lack of insight into psychosocial influences upon the illness (P<0.001, RR 7.49), refusal to engage with psychological services (P<0.05, RR 4.55), involvement of > 3 consultants (P<0.05, RR 7.00) and lodging of a manipulative complaint (P<0.05, RR 3.25). Conclusion: Healthcare consumerism in families lacking insight is deleterious for the child with FAP. Robust systems are necessary to protect the child (and their physician) from the consequences of consumerism in medicine