A Primary Care Perspective on Prevailing Assumptions about Persistent Medically Unexplained Physical Symptoms

Abstract

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.

Primary Care Consultations About Medically Unexplained Symptoms: How Do Patients Indicate What They Want?

“…Mean age was 46 years (range 16-85). They had consulted GPs a mean of 6.1 times in the previous 6 months (range 0-39) and reported a mean of 2.3 symptoms (range [1][2][3][4][5][6][7][8] in the recorded consultation. These characteristics did not differ between those providing complete and incomplete data on the Patient Requests Form.…”

“…Patients with medically unexplained symptoms (MUS) have as poor a quality of life as those with comparable symptoms caused by disease 6,7 . Many doctors find these patients challenging [8][9][10][11][12] and provide disproportionate levels of health care, which is often ineffective and might sometimes increase patients' dependence 7,[13][14][15] .…”

The influence of complaint symptoms on health care utilisation, medicine use, and sickness absence

“…Prior studies have shown that multiple somatic symptoms are related to the depression and tension symptoms [34,37]. It is apparent that the results regarding reported depression and tension symptoms could possibly indicate a psychiatric disorder, as has been reported earlier [12,23,37,39].…”

“…Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder [12]. In a sample of primary care patients with persistent unexplained physical symptoms, Stanley et al [23] found little evidence of discrete somatic syndromes. However, van der Wall et al [24] reported that musculoskeletal complaints are common among the adult general population.…”

“…The impact and pattern of symptoms over time is less well studied [1,23]. Even fewer have examined the impact of each individual symptom in relation to prospective health service utilisation [12,23]. Gureje et al [21] reported that somatisation syndrome shows considerable change over time.…”