Addressing the needs of patients with medically unexplained symptoms: 10 key messages, 2018

P

Pechius

Senior Member (Voting Rights)
INTRODUCTION
Many GPs find the care of patients with medically unexplained symptoms (MUS) challenging. Therefore, the WONCA Working Party for Primary Mental Health asked for MUS guidance for family doctors worldwide in order to improve the care of patients with MUS globally. This article is a summary of this guidance.

1. MEDICALLY UNEXPLAINED SYMPTOMS IS AN ONGOING WORKING HYPOTHESIS
MUS are physical symptoms that have existed for several weeks and for which adequate medical examination or investigation have not revealed any condition that sufficiently explains the symptoms. MUS is a working hypothesis based on the (justified) assumption that somatic or psychiatric pathology have been adequately detected and treated, but that the clinical condition presented by the patients was not adequately resolved. Any change in symptoms could be a reason to revise the working hypothesis of MUS.1 For some patients with physical symptoms, a somatic or psychiatric condition may be present. However, if the physical symptoms are more severe or more persistent, or limit functioning to a greater extent than expected based on the condition in question, they too are referred to as MUS.

2. MEDICALLY UNEXPLAINED SYMPTOMS CAN BE SEEN AS A CONTINUUM OF SEVERITY
MUS can be seen as a continuum ranging from self-limiting symptoms to recurrent and/or persisting symptoms and symptom disorders. The group with recurrent and/or persisting symptoms is especially relevant in primary care as these …
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https://bjgp.org/content/68/674/442

Don't have the access to full text, but I don't know if I want to. My blood is already boiling.

This part is interesting:
MUS is a working hypothesis based on the (justified) assumption that somatic or psychiatric pathology have been adequately detected and treated, but that the clinical condition presented by the patients was not adequately resolved.
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How can it be justified? How bent are these people writing this nonsense?
 
The other sections are

Sounds same old BPS (or BS) ! involving graded “get over it”, I particularly like the “give an explanation” for the unexplained. We should be aware of number three using exactly the same Language our drs are using, except they see mainly a biological trigger only , not significant perpetuating abnormalities
 
6. PROVIDE A TARGETED AND TANGIBLE EXPLANATION
GPs should provide a targeted and tangible explanation in the patient’s language and cultural model about what is causing the symptoms. Information obtained during the structured exploration of the symptoms should be incorporated in this explanation. Patients benefit from ‘... an explanation ... that make sense, removes any blame from the patient, and generate ideas about how to manage the symptoms’.3 Explanations that are co-created by patient and GP are most likely to be accepted by patients.
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:confused: where the hell does truth fit in to this approach?

Six people wrote this rubbish and the British Journal of General Practice published it. They all should be ashamed of their sloppy thinking and willingness to collude to deceive patients. (Is it obvious that I have a headache and no tolerance for stupidity today?).

Here are the authors' names:

TC Olde Hartman, PhD, MD, GP, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
CLK Lam, MD, FRCGP, MICGP, FHKAM (Family Medicine), professor and head, Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong.
J Usta, MSc, MD, clinical associate professor, Internal Medicine, American University of Beirut, Beirut, Lebanon.
D Clarke, MD, clinical assistant professor of gastroenterology emeritus, Oregon Health and Science University, Portland, OR, US.
S Fortes, MSc, PhD, MD, psychiatrist, University of Rio de Janeiro State, Rio de Janeiro, Brazil.
C Dowrick, MSc, MD, professor of primary medical care, University of Liverpool, Liverpool, UK.

Address for correspondence

Tim C Olde Harteman, Radboud University Nijmegen Medical Center, Primary and Community Care, PO Box 9101, Nijmegen, 6500 HB, the Netherlands.
Email: tim.oldeHartman@radboudumc.nl

I'm reminded of Jen Brea's TED talk where she says that 'I don't know' is a beautiful thing, as it is only by acknowledging that that it's possible to move on to trying to find answers.
 
In the link given in Post 1 of this thread https://bjgp.org/content/68/674/442 has anyone else noticed the stuff in the right hand column?

Writing papers on MUS is a growth industry gone wild - rather like a cancer.

We recommend
  1. Medically unexplained symptoms: evidence, guidelines, and beyond
    Tim C olde Hartman et al., Br J Gen Pract
  2. Medically unexplained symptoms: evidence, guidelines, and beyond
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  3. What do guidelines and systematic reviews tell us about the management of medically unexplained symptoms in primary care?
    Tim C olde Hartman et al., BJGP Open
  4. Medically unexplained symptoms: continuing challenges for primary care
    Carolyn A Chew-Graham et al., Br J Gen Pract
  5. Somatic symptoms and depression: diagnostic confusion and clinical neglect
    Christopher Dowrick, Br J Gen Pract
  1. SC14 Interprofessional simulation training to address medically unexplained symptoms across the healthcare system
    M Fisher et al., BMJ STEL
  2. Frustrated by Patients With Hypochondria? What to Do
    Shelly Reese et al., Medscape
  3. DSM-5 Somatic Symptom Disorder Debate Rages On
    Deborah Brauser et al., Medscape
  4. Best Practices in the Clinical Management of Motor Symptoms Associated With Huntington Disease
    Medscape CME
  5. Primary and metastatic brain tumours in adults: summary of NICE guidance
    Alex Bates et al., The BMJ
 
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