Improving the Classification of Medically Unexplained Symptoms in Primary Care

Abstract

-Background: Many patients in primary care complain of physical symptoms not attributable to any known conventionally defined disease, i.e. medically unexplained symptoms (MUS).Objectives: This paper aims to present the problems with our current classification of MUS in general practice and propose new criteria for the classification of Medically Unexplained Symptoms in a future edition of the International Classification of Primary Care (ICPC).Methods: Discussion of European classification systems in relation to current evidence about MUS in primary care.Results: At present, clinical care and research are hampered by the lack of a valid and reliable diagnostic classification of MUS. A particular problem in primary care is that the diagnostic category of somatoform disorders only includes persistent cases and therefore offers no opportunity for the classification of many patients with MUS in general practice. We propose new diagnostic criteria for MUS that can easily be integrated in a future edition of the ICPC. The criteria introduce mild to moderate MUS into the chapter of general and unspecified health problems if the patient has at least three MUS during an episode of care, whereas severe conditions are kept in the psychological chapter under the diagnoses applied until now.Conclusion: A diagnosis and classification of MUS is essential for the prediction of prognosis and the choice of appropriate care for these patients in general practice. It remains to be evaluated in epidemiologic research whether the proposed classification criteria fulfil this purpose.

Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study

“…The present classifications of MUS appear inadequate for early recognition and satisfactory patient management [9,10]. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV), and the psychiatric chapters of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), MUS are classified as somatoform disorders [11,12].…”

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

“…Several of these will be categorized as suffering from medically unexplained symptoms (MUS). These represent conditions ranging from mild self-limiting symptoms to severe, disabling disorders [1,2] and account for 10-15% of all GP consultations [3,4]. When trying to classify these patients and offer them treatment and support, GPs face several management challenges.…”

Diagnoses of Patients with Severe Subjective Health Complaints in Scandinavia: A Cross Sectional Study

“…Our results show that the diversity in symptom diagnoses is even larger than the list of unspecific symptom diagnoses for patients with MUS, suggested by Rosendal et al [29]. In the present study, disease diagnoses (ICPC-2 A-Z 70-99) were also applied.…”

“…There is no consensus as how to improve the systems. Several suggestions exist, including a multiaxial coding system [31] or a new category of mild-to-moderate unspecific complaints in the ICPC-2 system [29]. A new uniform diagnosis must acknowledge the multimorbidity as a key issue in these patients [20].…”