What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

Background. There are few longitudinal studies of patients with medically unexplained symptoms. The aim of this study was to investigate outcome in frequent attenders in secondary care who present repeatedly with medically unexplained symptoms.Method. Forty-eight patients presenting with medically unexplained symptoms, from a sample of 61, participated in a 3-year follow-up study. Psychiatric morbidity, functional impairment and use of services were evaluated.Results. At follow-up there was a high prevalence of psychiatric morbidity with 69% having at least one psychiatric diagnosis. The sample continued to be high users of a range of health services and substantial functional impairment was reported.Conclusion. In this group of frequent attenders with medically unexplained symptoms outcome as measured by psychiatric morbidity, service use and functional impairment remained poor after 3 years.

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Adapted Cognitive-Behavior Therapy for Medically Unexplained Symptoms in Secondary Care Reduces Hospital Contacts

Psychosomatics ◽

10.1016/j.psym.2010.12.008 ◽

2011 ◽

Vol 52 (2) ◽

pp. 194-196 ◽

Cited By ~ 6

Author(s):

Helen Tyrer ◽

Peter Tyrer ◽

Ian Lovett

Keyword(s):

Behavior Therapy ◽

Cognitive Behavior Therapy ◽

Secondary Care ◽

Medically Unexplained Symptoms ◽

Cognitive Behavior ◽

Medically Unexplained ◽

Unexplained Symptoms

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Experts' opinions on the management of medically unexplained symptoms in primary care. A qualitative analysis of narrative reviews and scientific editorials

Family Practice ◽

10.1093/fampra/cmr004 ◽

2011 ◽

Vol 28 (4) ◽

pp. 444-455 ◽

Cited By ~ 36

Author(s):

M. Heijmans ◽

T. C. olde Hartman ◽

E. van Weel-Baumgarten ◽

C. Dowrick ◽

P. L. B. J. Lucassen ◽

...

Keyword(s):

Primary Care ◽

Qualitative Analysis ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Medically unexplained symptoms in secondary care

BMJ ◽

10.1136/bmj.322.7289.745 ◽

2001 ◽

Vol 322 (7289) ◽

pp. 745-746 ◽

Cited By ~ 9

Author(s):

J. Turner

Keyword(s):

Secondary Care ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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The interpretation of low mood and worry by high users of secondary care with medically unexplained symptoms

BMC Family Practice ◽

10.1186/1471-2296-12-107 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 4

Author(s):

Christopher Burton ◽

Kelly McGorm ◽

David Weller ◽

Michael Sharpe

Keyword(s):

Secondary Care ◽

Medically Unexplained Symptoms ◽

Low Mood ◽

Medically Unexplained ◽

Unexplained Symptoms

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Psychosomatic therapy for patients frequently attending primary care with medically unexplained symptoms, the CORPUS trial: study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-019-3913-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Margreet S. H. Wortman ◽

Johannes C. van der Wouden ◽

Janneke P. C. Grutters ◽

Bart Visser ◽

Willem J. J. Assendelft ◽

...

Keyword(s):

Primary Care ◽

Economic Evaluation ◽

Usual Care ◽

Secondary Care ◽

Outcome Measure ◽

Medically Unexplained Symptoms ◽

Secondary Outcome ◽

Patient Specific ◽

Medically Unexplained ◽

Unexplained Symptoms

Abstract Background Medically unexplained symptoms (MUS) are highly prevalent and pose a burden both on patients and on health care. In a pilot study psychosomatic therapy delivered by specialised therapists for patients with MUS showed promising results with regard to patient’s acceptability, feasibility and effects on symptoms. The aim of this study is to establish whether psychosomatic therapy by specialised psychosomatic exercise therapists is cost- effective in decreasing symptoms and improving functioning in patients who frequently consult their general practitioner (GP) with MUS. Methods A randomised effectiveness trial with an economic evaluation in primary care with 158 patients aged 18 years and older who are frequently consulting their GP with MUS. Patients will be assigned to psychosomatic therapy in addition to usual care or usual care only. Psychosomatic therapy is a multi-component and tailored intervention, aiming to empower patients by applying psycho-education, relaxation techniques, mindfulness, cognitive approaches and/or graded activity. Patients assigned to the psychosomatic therapy receive 6 to 12 sessions of psychosomatic therapy, of 30–45 min each, delivered by a specialised exercise or physical therapist. Primary outcome measure is patient-specific functioning and disability, measured with the Patient-Specific Functional Scale (PSFS). Secondary outcome measures are symptom severity, consultation frequency and referrals to secondary care, patient satisfaction, quality of life and costs. Assessments will be carried out at baseline, and after 4 and 12 months. An economic evaluation alongside the trial will be conducted from a societal perspective, with quality-adjusted life years (QALYs) as outcome measure. Furthermore, a mixed-methods process evaluation will be conducted. Discussion We expect that psychosomatic therapy in primary care for patients who frequently attend the GP for MUS will improve symptoms and daily functioning and disability, while reducing consultation frequency and referrals to secondary care. We expect that the psychosomatic therapy provides value for money for patients with MUS. Trial registration Netherlands Trial Register, ID: NL7157 (NTR7356). Registered 13 July 2018.

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Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v5i3.1341 ◽

2017 ◽

Vol 5 (3) ◽

pp. 389

Author(s):

Marta J Buszewicz

Keyword(s):

Clinical Practice ◽

Health Service ◽

Secondary Care ◽

Medically Unexplained Symptoms ◽

Physical Symptoms ◽

Normal Function ◽

Negative Consequences ◽

Postgraduate Level ◽

Medically Unexplained ◽

Unexplained Symptoms

Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy. Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.

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