Assessment and immediate management of patients with medically unexplained symptoms in primary care and general hospital settings

Medically unexplained symptoms (MUS) are physical symptoms that doctors cannot fully explain by organic pathology, which distress or impair the functioning of the patient. They are disproportionate in the distress or effects on functioning compared with the physical pathology that is present. MUS usually have a physiological explanation that is most often reversible. There may or may not be an associated emotional disorder or psychosocial problem. MUS is an expensive problem and some patients with MUS may repeatedly consult primary care or secondary care health services. MUS require patient-centred communication and good clinical diagnostic skills for their proper diagnosis. Most MUS are self-limiting but others are associated with long-standing poor function. However, around 10% of MUS are in fact early manifestations of underlying physical pathology, so the main tasks of the doctor are accurate clinical assessment, clinical vigilance, ongoing support and explanation to the patient. Explanation must fit with the patient’s understanding of their problems and their beliefs about their symptoms. The assessment of MUS and its management are outlined, including a four-stage model for managing MUS: stage 1: feeling understood; stage 2: establishing the agenda through negotiation; stage 3: action stage (clarification, acknowledgement of distress, explanation treatment; stage 4: termination of the consultations. Additional approaches for frequent attendance with MUS are also discussed.