Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

Abstract

Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy.

Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.