Medically unexplained symptoms: continuing challenges for primary care

Abstract

Bodily symptoms are common in community samples, but not all people consult for medical advice about such symptoms. Medically unexplained symptoms (MUS) refer to persistent bodily complaints for which adequate examination (including investigation) does not reveal sufficiently explanatory structural or other specified pathology.1 MUS are common, with a spectrum of severity, and patients are found everywhere within the healthcare system.2 It has been estimated that MUS account for up to 45% of all general practice consultations, 3 while a study based in secondary care indicated that about 50% of patients had no clear diagnosis at 3 months. 2 WHAT ARE THE COSTS OF MUS?The annual NHS cost for MUS in adults of working age in England was estimated to be £2.89 billion in 2008/2009 (11% of total NHS spend), while sickness absence and decreased quality of life for people with MUS was estimated as costing over £14 billion per annum to the UK economy.

Hope, disappointment and perseverance: Reflections of people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Multiple Sclerosis participating in biomedical research. A qualitative focus group study

“…Cocksedge and colleagues have reflected on the doctor–patient relationship in complex chronic illness, highlighting the role of GPs in “holding” patients at times of uncertainty and fear, even when diagnosis is unclear and uncertain and/or there is no cure for the illness . Chew‐Graham and others have explored the dilemmas faced by GPs in making diagnosis without confirmatory tests, and the challenges to a GP's role within a healthcare system in which biomedical diagnosis is often a prerequisite for treatment or support …”

Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified

“…Some leading UK clinicians characterise MUS as a major cost problem to the NHS and a challenge to GPs [8], with reference to studies that suggest MUS account for up to 45% of GP consultations [70]. If correct (we think not), IAPT would collapse under the weight of MUS patientsa reductio ad absurdum.…”

“…Medically unexplained symptoms refer to persistent bodily complaints for which adequate examination (including investigation) does not reveal sufficiently explanatory structural or other specified pathology [2,8]. MUS are also referred to as 'functional somatic syndromes'; bodily complaints such as dizziness, fatigue, pain, headaches and so on, that remain unexplained [9].…”

“…In practice, community doctors encounter a considerable percentage of patients with unexplained symptomsa 45% rate is mentioned in the MUS literature to emphasise the 'MUS problem or dilemma' [8]. However, this is not the same as the actual rate for persistent MUS, given a patient is rarely diagnosed on first visit to a GP.…”

‘MUS’ or ‘DEN’?

“…1 Since learning the latest about the linked conditions of mast cell activation syndrome, postural orthostatic tachycardia syndrome, dysautonomia, and the hypermobility syndromes (including Ehlers-Danlos), I have yet to find anyone with 'MUS'. I just find patients who have been failed by a lack of medical knowledge among their caring clinicians.…”