Medically unexplained somatic symptoms: common and costly – a positive approach

Medically unexplained symptoms (MUS) is a term commonly used for persistent bodily complaints for which adequate examination and investigations do not reveal an underlying pathology. That is, they are troublesome physical sensations that do not have an explanation in current disease models.

 

Although a contentious term, MUS is one that is understood by most physicians. We will use it here to include functional somatic syndromes (FSS) and other newer descriptors, such as somatic symptom disorder (SSD) and health anxiety, which will be explained later.

 

In practice, despite having a strong suspicion that there is no serious medical problem, physicians are trained to investigate symptoms and some can see this as their only role in these cases. However, as well as the desire to provide the best possible care, physicians may be driven by a worry about missing something serious or may not feel skilled at 'explaining the unexplained' satisfactorily to patients. Either way, they may be left with a sense of dissatisfaction about their management.

 

Patients with so-called MUS often report feeling unsupported and confused. These dynamics can often lead to extensive, unproductive and expensive investigations, with patients feeling no better and clinicians feeling frustrated.

 

The aim of this module is to enhance physicians' knowledge and confidence in dealing with patients with MUS. Skills required in interviewing patients who do not appear to have organic pathology are outlined, and information on managing patients presenting with these symptoms is discussed towards the end of the module.

 

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