Medically unexplained symptoms and the disease label

Abstract

Medically unexplained symptoms are a source of frustration for clinician and patient alike. They simultaneously test the credibility of the doctor and the patient; the former, for his or her inability to label the patient's complaint, and the latter, for the ignominy of being perceived to have a factitious symptom. This review explores the discursive construction of such symptoms in the medical literature in order to appreciate the context in which medicine understands and manages non-diagnosed complaints. It uses medically unexplained symptoms as a heuristic for understanding the role of classification in constituting medicine as a social authority. In the absence of diagnostic category, medically unexplained symptoms are recast as a discrete category of their own. However, this category implies the infallibility of the physician and the relevance of the medical model in all circumstances. It transfers responsibility for the disorder to the patient in a way that may hinder resolution, and it ignores socio-historical practices that influence when and why patients consult a physician.

Classification, Disease, and Diagnosis

“…Medicine, for example, unconsciously assigns to psychiatry temporary guardianship of boundaries between disease and health; misunderstood conditions are directed its way, until their mechanisms are clarified and treatments identified (Rosenberg 2006). Conditions such as pellagra, paresis, multiple sclerosis, and other medically unexplained symptoms are shuttled to psychiatry as a catch-all discipline for that which medicine does yet understand (Jutel 2010b).…”

The social negotiation of illness: Doctors’ role as clinical or political in diagnosing patients with medically unexplained symptoms

“…This focus on the patient's social situation is a process in which doctors, welfare officers (who are responsible for granting money to the ill person) and the political system become central actors in the negotiation of the sick role. As much research has focused on people with MUS, studies on the influence of the medical classification processes are particularly salient (for example, Wileman et al, 2002;Werner and Malterud, 2003;Ring et al, 2004;Brookes-Howell, 2006;Nettleton, 2006;Jutel, 2010).…”

“…Some studies have focused on the medical classification of contested symptoms (for example, Brown, 2007;Smith and Dwamena, 2007;Jutel, 2010;White, 2010;Greco, 2012), and some studies have a particular interest in investigating the doctor-patient relationship when the patient has MUS, often with a focus on the difficulties of being a patient when a biomedical diagnosis is lacking (for example, Werner and Malterud, 2003;Madden and Sim, 2006). Other studies have focused on the medical system when doctors interact with patients with MUS (for example, Pilnick, 2009).…”

ARTICULO ORIGINAL-2016: La Valoración de Incapacidades y los Síntomas Físicos Médicamente Inexplicables

“…9 Pues existen limitaciones de 'diagnóstico' de estos síntomas como una entidad, más bien es un diagnóstico de exclusión (15) El diagnóstico de los MUPS se realiza mediante distintos nombres -la mayoría inespecíficos-en función de la especialidad médica en que se hace la consulta, aunque el solapamiento clínico es lo habitual . 4 Debido a la falta de consenso en cuanto a la definición, la investigación sobre los aspectos relacionados con el MUPS constituye un reto.…”

“…-Otras enfermedades psiquiátricas, como depresión, ataques de pánico o trastorno delirante, pueden simular en una fase inicial un trastorno somatoforme. Para Jutel, (15) la interpretación clínica en lugar de diagnóstico clínico es una manera de reconciliar la medicina y el individuo, el síntoma inexplicable y la angustia del paciente. La medicina debe orientarse a la claridad y la objetividad, debe permitir que el paciente cuente su padecimiento aun en ausencia de patología orgánica y permitir un marco alternativo para explicar su queja.…”