Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations - Houwen et al BJGP 2020

[Sly Saint]

• Received May 27, 2019.
• Revision requested June 18, 2019.
• Accepted July 16, 2019.

• © British Journal of General Practice 2020
  
  

  Abstract
  Background It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.
  
  Aim To establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.
  
  Design and setting This was a qualitative study. Data were collected in the Netherlands in 2015.

  Method GPs’ consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.

  Results A total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.

  Conclusion
  
  Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation.
  GPs are triggered to label symptoms as medically unexplained by patients’ symptom presentation, symptom patterns, and symptom attribution.
  This suggests that non-analytical reasoning was a central component in their thought process.

  
  https://bjgp.org/content/early/2020/01/13/bjgp20X707825
  
  
  
  

 

[rvallee]

100%

This suggests that non-analytical reasoning was a central component in their thought process.

It's mostly a reflex, the "default" option. There should never be a default option, especially one that is not validated and has a huge history of failure but it's the fact that it is the default option that makes it common. It is a belief and beliefs require no evidence. This is the core and foundation of MUS: belief and nothing else. It has no place in modern science and even less so in the practice of modern medicine.

But this is not the right way:

This suggests that non-analytical reasoning was a central component in their thought process.

They will behave very differently knowing they are recorded, keeping the worst behavior that is common out of consideration. There is interesting reflection over the superficial triggers for this, mostly having to do with patient presentation, but there is also a much wider variety of such superficial markers that would make the response to the exact same overall presentation and wording lead to very different outcomes if said by an introvert adolescent girl vs a tall, broad-shouldered middle-aged man wearing an expensive suit. It's entirely a crapshoot with zero consistency. Which we have been saying for decades so congrats on figuring out the obvious. I mean it, this is remarkable.

However I think this should be larger and bolder somewhat, even underlined and larger still:

This suggests that non-analytical reasoning was a central component in their thought process.

As a matter of fact, it is 100% of the thought process. All belief brought about by improperly validating an ideological structure into medical practice despite all evidence showing it is a useless anachronistic artifact of pre-science thought.

 

[Hutan]

Brian Hughes discusses this paper in a blog in 2022
Medical haste, COVID-19, and the mythology of “Medically Unexplained Symptoms”

The killer here is that a determination of so-called “Medically Unexplained Symptoms”, or MUS, is supposed to be a diagnosis of exclusion. Technically all other possible diagnoses need to be ruled out first. The symptoms can only be deemed “unexplained” if all other explanations are found wanting.

Doctors who diagnose a patient with MUS should form this view only after many hours of consideration. That is the logic of the deliberation required. It should take a very long time.

But it seems as though (some) doctors decide these things using processes other than logic.

* * *

I was reminded of this problem when I read the news from the Irish High Court yesterday. The Court has awarded a 20-year-old man compensation of €6 million because of a catastrophic misdiagnosis he received when he was just 14.

His symptoms — fatigue, brain fog, and numbness — will be familiar to many of us in these Covid times. The young boy’s doctors quickly declared these ailments to be “psychological”, and prescribed a regimen of mental health treatment and physiotherapy. But they were wrong. The boy in fact had a brain tumour, which, because of the physicians’ attachment to theories of psychological magic, went undetected — and thus untreated — for five months.



"the family were told the problems were psychological …and the boy was referred to the mental health services and physiotherapy"

Sound familiar #pwME?#MECFS

€6m settlement over brain tumour diagnosis delay

 

[Andy]

Blog previously posted here, Blog: The Science Bit by Brian Hughes