Medically Unexplained Physical Symptoms

Excerpt

Physical symptoms are the most common reason patients seek medical attention. Among those presenting with symptoms, up to a third remain unexplained, even after thorough investigation1. Fortunately, most patients with unexplained symptoms improve and prospective studies show that the rate of resolution is similar to patients with explained symptoms2. However, there is a subgroup with persistent unexplained symptoms. There are numerous colorful descriptions of such patients, such as “difficult,” “frustrating” or “heartsink,”3 with heartsink referring to the feeling clinicians have when they see a particular name on their schedule. While many patients have unexplained symptoms, the term “medically unexplained symptoms” has taken on a life of its own. Studies investigating the characteristics of “difficult” patient encounters reveal that both patient and physician characteristics play a role.4 These patients have multiple, persistent, unexplained physical symptoms. Their symptoms are more severe; they have poor functioning and tend not to improve over time. There is some evidence that less experienced clinicians and those with poorer psychosocial orientation experience a greater percentage of encounters as difficult. Both parties in these encounters emerge unsatisfied and short-term outcomes are poor. …