Medically unexplained symptoms: evidence, guidelines, and beyond

Hartman, Tim olde; Woutersen-Koch, Hèlen; Horst, Henriëtte E. van der

doi:10.3399/bjgp13x675241

Cited by 38 publications

(28 citation statements)

References 11 publications

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“…In fact, we found that patients’ expectations regarding the communication element “prescribe a medicine” were significantly lower for MUS patients than for MES patients. Although previous studies reported that GPs experience difficulties in managing MUS consultations, we found that patients with MUS rated their experiences for task‐related and affect‐oriented communication of their GP higher than their expectations. We assume that GPs’ general perception regarding managing patients with MUS concerns severe MUS patients (ie, having multiple symptoms with substantial symptom related disability and health‐care use, having a poor prognosis) while the included MUS patients in our study did probably not belong to this category of severe MUS patients as most patients with MUS and GPs did not report a high number of symptoms or the involvement of different multiple body systems or emotional comorbid disorders.…”

Section: Discussioncontrasting

confidence: 91%

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The association between patients’ expectations and experiences of task‐, affect‐ and therapy‐oriented communication and their anxiety in medically unexplained symptoms consultations

Houwen¹,

Moorthaemer²,

Akkermans³

et al. 2018

Health Expectations

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Background It is unknown whether patients with medically unexplained symptoms (MUS) differ from patients with medically explained symptoms (MES) regarding their expectations and experiences on task‐oriented communication (ie, communication in which the primary focus is on exchanging medical content), affect‐oriented communication (ie, communication in which the primary focus is on the emotional aspects of the interaction) and therapy‐oriented communication (ie, communication in which the primary focus is on therapeutic aspects) of the consultation and the extent to which GPs meet their expectations. Objective This study aims to explore (a) differences in patients’ expectations and experiences in consultations with MUS patients and patients with MES and (b) the influence of patients’ experiences in these consultations on their post‐visit anxiety level. Study design Prospective cohort. Setting Eleven Dutch general practices. Measurements Patients completed the QUOTE‐COMM (Quality Of communication Through the patients’ Eyes) questionnaire before and after the consultation to assess their expectations and experiences and these were related to changes in patients’ state anxiety (abbreviated State‐Trait Anxiety Inventory; STAI). Results Expectations did not differ between patients with MUS and MES. Patients presenting with either MUS or MES rated their experiences for task‐related and affect‐oriented communication of their GP higher than their expectations. GPs met patients’ expectations less often on task‐oriented communication in MUS patients compared to MES patients (70.2% vs 80.9%; P = ˂0.001). Affect‐oriented communication seems to be most important in reducing the anxiety level of MUS patients (β −0.63, 95% Cl = −1.07 to −0.19). Discussion Although the expectations of MUS patients are less often met compared to those of MES patients, GPs often communicate according to patients’ expectations. Experiencing affect‐oriented communication is associated with a stronger reduction in anxiety in patients with MUS than in those with MES. Conclusion GPs communicate according to patients’ expectations. However, GPs met patients’ expectations on task‐oriented communication less often in patients with MUS compared to patients with MES. Experiencing affect‐oriented communication had a stronger association with the post‐consultation anxiety for patients with MUS than MES.

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Section: Discussioncontrasting

confidence: 91%

“…Medically unexplained symptoms (MUS) are symptoms for which, after a thorough history taking, physical and additional investigations, no pathological cause can be found . As 3%‐11% of consultations in primary care concern MUS, GPs often face patients with MUS .…”

Section: Introductionmentioning

confidence: 99%

The association between patients’ expectations and experiences of task‐, affect‐ and therapy‐oriented communication and their anxiety in medically unexplained symptoms consultations

Houwen¹,

Moorthaemer²,

Akkermans³

et al. 2018

Health Expectations

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“…First, prior negative expectations of GPs about patients with MUS may have been translated into their language use. Patients with MUS are often perceived as difficult patients [20] and physicians experience difficulties when communicating with them [38]. It is possible that differences in language use reflect GPs' own discomfort in communicating with these patients.…”

Section: Message Directness In Relation To Patient Anxietymentioning

confidence: 99%

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Stortenbeker

Houwen

Lucassen

et al. 2018

Patient Education and Counseling

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“…Patients with medically unexplained physical symptoms (MUPS) are substantially prevalent in the caseload of general practitioners and medical specialists [1,2]. Medical specialists find patients with invalidating symptoms without underlying pathology much more difficult to handle than patients with symptoms that are medically explained [3].…”

Section: Introductionmentioning

confidence: 99%

Training specialists to write appropriate reply letters to general practitioners about patients with medically unexplained physical symptoms; A cluster-randomized trial.

Weiland

Blankenstein

Willems

et al. 2015

Patient Education and Counseling

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Medically unexplained symptoms: evidence, guidelines, and beyond

Cited by 38 publications

References 11 publications

The association between patients’ expectations and experiences of task‐, affect‐ and therapy‐oriented communication and their anxiety in medically unexplained symptoms consultations

The association between patients’ expectations and experiences of task‐, affect‐ and therapy‐oriented communication and their anxiety in medically unexplained symptoms consultations

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Training specialists to write appropriate reply letters to general practitioners about patients with medically unexplained physical symptoms; A cluster-randomized trial.

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