Enhanced care by generalists for functional somatic symptoms and disorders in primary care

Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

“…ACCEPTED MANUSCRIPT 8 another developed new, possibly cardiac, symptoms and was referred to a cardiologist. In both cases there was nothing from the consultation transcripts to suggest serious medical conditions were overlooked,…”

“…GPs currently lack the confidence and skills to manage medically unexplained symptoms effectively [4] and specialist services rarely achieve more than temporary reassurance for patients by excluding disease [31]. Additionally, previously developed brief approaches for GPs within ordinary consultations, have been found to be ineffective [8]. The Symptoms Clinic Intervention is a constructive and generalisable alternative which has the potential to substantially reduce patients' symptoms and their impact on daily living and subsequently on healthcare use.…”

“…While there is evidence for modest effectiveness of psychological interventions for MUS in specialist settings [7], there is currently no strong evidence for effectiveness of treatment for patients with multiple MUS in primary care. Our earlier Cochrane systematic review found no benefit from very brief interventions but raised the possibility that moderately intensive interventions -approximately two hours of consultation time might have value [8]. We recently developed the Symptoms Clinic Intervention (SCI) -a GP with Special Interest intervention for patients with multiple physical symptoms -as a moderate intensity intervention to be delivered by a specially trained primary care physician [9].…”

Socially constructed and structurally conditioned conflicts in territories of medical uncertainty

“…MUPS-consultations are characterised as a war-zone (Lian and Robson 2017), and described as one of the most challenging clinical encounters in contemporary Western societies (Rief and Broadbent 2007). In consultation rooms, MUPSpatients experience great dissatisfaction (Lian and Robson 2017;Rosendal et al 2013;Taylor et al 2012;Weiland et al 2012) and poor clinical outcomes (Rosendal et al, 2013;Weiland et al 2012). Health professionals report feeling helpless, inadequate and pressurised (Anderson et al 2012;Dowrick et al 2008;Salmon et al 2005).…”

Outcomes in systematic reviews of complex interventions never reached “high” GRADE ratings when compared with those of simple interventions

“…X X X Bennett[46] X X X X X X Bisson[31] X X X X X Churchill[32] X X X X X Cooney[33] X X X X Coren[47] X X X X X X X X Dangour[48] X X X X X X X X Fellmeth[34] X X X X X X X Fletcher-Watson[35] X X X X X Hunot[36] X X X X James[37] X X X X X Langford[49] X X X X X X X X X Livingstone[38] X X X X X X Martin[39] X X X X X X X Mayo-Wilson[40] X X X X X Oono[41] X X X X X X Parab[42] X X X X X Pega[50] X X X X X X X Petrosino[43] X X X X X Rosendal[44] X X X X Shinohara[45] X X X X Thomson[8] X X X X X X X Turley[51] X X X X X X X Winokur[52] X X X X X X ''Simple'' intervention reviews Brown[53] Cipriani[54] Guaiana[55] …”