How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor’s level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

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Symptom management for medically unexplained symptoms in primary care: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp19x701849 ◽

2019 ◽

Vol 69 (681) ◽

pp. e254-e261 ◽

Cited By ~ 5

Author(s):

Janna Gol ◽

Tom Terpstra ◽

Peter Lucassen ◽

Juul Houwen ◽

Sandra van Dulmen ◽

...

Keyword(s):

General Practice ◽

Qualitative Study ◽

Symptom Management ◽

Management Strategies ◽

Real Life ◽

Medically Unexplained Symptoms ◽

Daily Practice ◽

Activity Level ◽

Medically Unexplained ◽

Unexplained Symptoms

BackgroundGPs have a central position in the care of patients with medically unexplained symptoms (MUS), but GPs find their care challenging. Currently, little is known about symptom management by GPs in daily practice for patients with MUS.AimThis study aimed to describe management strategies used by GPs when confronted with patients with MUS in daily practice.Design and settingQualitative study in which videos and transcripts of 39 general practice consultations involving patients with MUS in the region of Nijmegen in the Netherlands in 2015 were analysed.MethodA thematic analysis of management strategies for MUS used by GPs in real-life consultations was performed.ResultsThe study revealed 105 management strategies in 39 consultations. Nearly half concerned symptom management; the remainder included medication, referrals, additional tests, follow-up consultations, and watchful waiting. Six themes of symptom management strategies emerged from the data: cognitions and emotions, interaction with health professionals, body focus, symptom knowledge, activity level, and external conditions. Advice on symptom management was often non-specific in terms of content, and ambiguous in terms of communication.ConclusionSymptom management is a considerable part of the care of MUS in general practice. GPs might benefit from support in how to promote symptom management to patients with MUS in specific and unambiguous terms.

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Management strategies for medically unexplained symptoms in general practice: A qualitative study

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2017.03.296 ◽

2017 ◽

Vol 97 ◽

pp. 171

Author(s):

T. Terpstra ◽

J. Gol ◽

P. Lucassen ◽

J. Houwen ◽

J. Rosmalen ◽

...

Keyword(s):

General Practice ◽

Qualitative Study ◽

Management Strategies ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms

Psychological Medicine ◽

10.1017/s003329170200658x ◽

2003 ◽

Vol 33 (3) ◽

pp. 519-524 ◽

Cited By ~ 33

Author(s):

S. REID ◽

T. CRAYFORD ◽

A. PATEL ◽

S. WESSELY ◽

M. HOTOPF

Keyword(s):

Functional Impairment ◽

Secondary Care ◽

Service Use ◽

Psychiatric Morbidity ◽

Medically Unexplained Symptoms ◽

Follow Up Study ◽

Frequent Attenders ◽

Medically Unexplained ◽

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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The Art of Medicine

10.1093/oso/9780192845184.003.0004 ◽

2021 ◽

pp. 29-41

Author(s):

David Beaumont

Keyword(s):

Medical Training ◽

Medical Model ◽

Medically Unexplained Symptoms ◽

Modern Medicine ◽

Hippocratic Oath ◽

Patient Centred Care ◽

Balint Groups ◽

Do No Harm ◽

Medically Unexplained ◽

Unexplained Symptoms

The author’s medical training. Hippocrates and the Hippocratic oath, but the shift from ‘First, do no harm’ to modern medicine’s mantra, ‘First, do something’. Modern medical education, and patient contact throughout. A consultant physician’s ward round in the bad old days. The film Patch Adams, based on the life of the maverick Dr Hunter ‘Patch’ Adams, founder of The Gesundheit Institute, and his vision of patient-centred care. The shift from ‘the cholecystitis in bed 3’ to patient-centred care—and patient-centred medical training. The RCGP’s vision statement of 2019, Fit for the Future. Ivan Illich’s 1974 critique of medicine in Medical Nemesis. His term iatrogenesis (clinical, social, cultural). RACP’s EVOLVE initiative seeking evidence of efficacy. Dr John Powles’ 1973 paper ‘On the limitations of modern medicine’. Pain management and the opioid epidemic. The social determinants of health explained. The biopsychosocial model compared with the reductionist medical model. Medically unexplained symptoms and the difficulty of diagnosis. Buck-passing. The purpose and use of Balint groups. Medically unexplained symptoms and chest pain.

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