Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Patients’ experiences of living with medically unexplained symptoms (MUS): a qualitative study

Authors: Agnieszka Sowińska, Sławomir Czachowski

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

Patients with medically unexplained symptoms (MUS) are common in primary care, and pose a communicative and therapeutic challenge to GPs. Although much has been written about GPs’ frustration and difficulties while dealing with these patients, research presenting the patients’ perspectives on MUS still seems to be scarce. Existing studies have demonstrated the patients’ desire to make sense of symptoms, addressed the necessity for appropriate and acceptable explanation of MUS, and revealed stigmatization of patients with symptoms of mental origin. Treatment in primary care should focus on the patient’s most essential needs and concerns. The objective of this paper is to explore Polish patients’ perspectives on living with MUS.

Methods

A qualitative content analysis of 20 filmed, semi-structured interviews with patients presenting MUS (8 men and 12 women, aged 18 to 57) was conducted. All patients were diagnosed with distinctive somatoform disorders (F45), and presented the symptoms for at least 2 years. The interviews were transcribed verbatim and analysed independently by two researchers.

Results

Four major themes emerged: (1) experiences of symptoms; (2) explanations for symptoms; (3) coping; (4) expectations about healthcare. Within the first theme, the patients identified the following sub-themes: persistence of symptoms or variability, and negative emotions. Patients who observed that their symptoms had changed over time were better disposed to accept the existence of a relationship between the symptoms and the mind. The second theme embraced the following sub-themes: (1) personal explanations; (2) social explanations; (3) somatic explanations. The most effective coping strategies the patients mentioned included: the rationalization of the symptoms, self-development and ignoring the symptoms. The majority of our respondents had no expectations from the healthcare system, and stated they did not use medical services; instead, they admitted to visiting psychologists or psychiatrists privately.

Conclusion

Patients with MUS have their own experiences of illness. They undertake attempts to interpret their symptoms and learn to live with them. The role of the GP in this process is significant, especially when access to psychological help is restricted. Management of patients with MUS in the Polish healthcare system can be improved, if access to psychologists and psychotherapists is facilitated and increased financial resources are allocated for primary care. Patients with MUS can benefit from a video/filmed consultation with a follow-up analysis with their GP.
Literature
1.
Steinbrecher N, Koerber S, Frieser D, Hiller W. The prevalence of medically unexplained symptoms in primary care. Psychosom. 2011;52(3):263–71.CrossRef
2.
Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosom. 1999;40:330–8.CrossRef
3.
4.
Aamland A, Malterud K, Werner EL. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice. BMC Fam Pract. 2014;15:107.CrossRefPubMedPubMedCentral
5.
Verhaak PF, Meijer SA, Visser AP, Wolters G. Persistent presentation of medically unexplained symptoms in general practice. Fam Pract. 2006;23(4):414–20.CrossRefPubMed
6.
Rosendal M, Olde Hartman TC, Aamland A, Van der Horst H, Lucassen P, Rudtz-Lilly An, Burton C. "Medically unexplained" symptoms and symptom disorders in primary care: prognosis-based recognition and classification. BMC Fam Pract 2017;18:18.
7.
Dwamena FC, Lyles JS, Frankel RM, et al. In their own words: qualitative study of high-utilising primary care patients with medically unexplained symptoms. BMC Fam Pract. 2009;10:67.CrossRefPubMedPubMedCentral
8.
Van den Bergh O, Witthöft M, Petersen S, Brown RJ. Symptoms and the body: taking the inferential leap. Neurosci Biobehav Rev. 2017;74:185–203.CrossRefPubMed
9.
Fink P, Rosendal M, Toft T. Assessment and treatment of functional disorders in general practice: the extended reattribution and management model – an advanced educational program for nonpsychiatric doctors. Psychosom. 2002;43:93–131.CrossRef
10.
11.
Kirmayer LJ, Groleau D, Looper KJ, Dao MD. Explaining medically unexplained symptoms. Can J Psychiatr. 2004;49(10):663–72.CrossRef
12.
Elderkin-Thompson V, Silver RC, Waitzkin H. Narratives of somatizing and non-somatizing patients in a primary care setting. J Health Psychol. 1998;3(3):407–28.CrossRefPubMed
13.
Nettleton S, Watt I, O’Malley L, Duffey P. Understanding the narratives of people who live with medically unexplained illness. Pat Educ Couns. 2005;56:205–10.CrossRef
14.
Bermingham SL, Cohen A, Hague J, Parsonage M. The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med. 2010;7(2):71–84.PubMedPubMedCentral
15.
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903–10.CrossRefPubMed
16.
17.
Kornelsen J, Atkins C, Brownell K, Woollard R. The meaning of patient experiences of medically unexplained physical symptoms. Qual Health Res. 2016;26(3):367–76.CrossRefPubMed
18.
Ring A, Dowrick CF, Humphris GM, Davies J, Salmon P. The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci and Med. 2005;61(7):1505–15.CrossRef
19.
Lidén E, Björk-Brämberg E, Svensson S. The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: a phenomenological-hermeneutic study. Int J Qual Stud Health Well-being. 2015;10(2719) https://​doi.​org/​10.​3402/​qhw.​v10.​27191
20.
Claassen N, van Dessel FR, Velzeboer JC, van der Wouden JC, et al. Patients’ perspectives on improvement of medically unexplained physical symptoms: a qualitative analysis. Ment Health Fam Med. 2015;11:42–8.
21.
22.
Salmon P, Peters S, Stanley I. Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ. 1999;318:372–6.CrossRefPubMedPubMedCentral
23.
Freidl M, Spitzl SP, Prause W, Zimprich F, Lehner-Baumgartner E, Baumgartner C, et al. The stigma of mental illness: anticipation and attitudes among patients with epileptic, dissociative or somatoform pain disorder. Int Rev Psychiatry Abingdon Engl. 2007;19:123–9.CrossRef
24.
Stone L. Blame, shame and hopelessness: medically unexplained symptoms and the ‘heartsink’ experience. Aust Fam Physician. 2014;43(4):191–5.PubMed
25.
Czachowski S, Pawlikowska T. ‘These reforms killed me’: doctors’ perceptions of family medicine during the transition from communism to capitalism. Fam Pract. 2011;28:437–43.CrossRefPubMed
26.
Sowińska A. ‘I must do everything to eliminate my negative attitude’: Polish general practitioners’ emotions toward patients with medically unexplained symptoms. In: Baider F, Cislaru G, editors. Linguistic approaches to emotions in context. Amsterdam: John Benjamins; 2014. p. 309–30.
27.
Czachowski S, Piszczek E, Sowińska A, Hartman TC. Challenges in the management of patients with medically unexplained symptoms in Poland: a qualitative study. Fam Pract. 2012;29:228–34.CrossRefPubMed
28.
Patton M. Qualitative research and evaluation methods. London: Sage; 2002.
29.
Czachowski S, Terluin B, Izdebski A, Izdebski P. Evaluating the cross-cultural validity of the polish version of the four-dimensional symptom questionnaire (4DSQ) using differential item functioning (DIF) analysis. Fam Pract. 2012;29:609–15.CrossRefPubMed
30.
Olde Hartman TC, Blankenstein AH, Molenaar AO, Bentz van den Berg D, Van der Horst HE, Arnold IA, Burgers JS, Wiersma Tj, Woutersen-Koch H. NHG Guideline on Medically Unexplained Symptoms (MUS). Huisarts Wet 2013;56(5):222–230.
31.
32.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRefPubMed
33.
Salmon P, Dowrick CF, Ring A, Humphris GM. Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners. Br J Gen Pract. 2004;54(500):171–6.PubMedPubMedCentral
34.
Nunes J, Ventura T, Encarnacao R, Pinto PR, Santos I. What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study. Ment Health Fam Med. 2013;10(2):67–79.PubMedPubMedCentral
35.
Kleinman A. The illness narratives: suffering, healing, and the human condition. New York: Basic Books; 1988.
36.
Löwe B, Spitzer RL, JBW W, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008;30:191–9.CrossRefPubMed
Metadata
Title
Patients’ experiences of living with medically unexplained symptoms (MUS): a qualitative study
Authors
Agnieszka Sowińska
Sławomir Czachowski
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0709-6

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue

Research article

Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory

Research article

Designing a framework for primary health care research in Canada: a scoping literature review

Research article

The capacity to work puzzle: a qualitative study of physicians’ assessments for patients with common mental disorders

Research article

Identifying frailty in primary care: a qualitative description of family physicians’ gestalt impressions of their older adult patients

Research article

Formative evaluation and adaptation of pre-and early implementation of diabetes shared medical appointments to maximize sustainability and adoption

Research article

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios