Medically unexplained physical symptoms (MUPs)
20% of new consultations may be for physical symptoms for which no organic cause isfound.
1/3 of these can persist.
Lot of controversies- patients advocacy groups. Lot of emotion.
Some medics do not like term MUPS as it supports belief we do not know what is wrong with patient - we do.
Somatising / Psychogenic / Functional etc.
Beware changing symptoms,
Strong link with mental illnesses.
- High workload {frequent attenders).
- Often referred for multiple investigation.
- GP-Pt relationship may suffer.
- Doctors trained in medical model and like to diagnose.
- GPs may be better at dealing with uncertainty.
Possibilities.
- Somatisation.
- Sub clinical / undiagnosed.
- Factitious I certification.
Clustering
- CFS (ME)
- Long Covid
- POTs
- IBS.
- Fibrmyalgia.
- SI.
- UD.
- (pain.
- Chest pain.
- Back pain.
- Numbness.
- TATT.
- Dizziness.
- Headache.
- SOB / hoarseness
- Pseudoseizures.
More common if
- Difficult childhood experiences.
- Poor parenting.
- Psychiatric disorders-esp. anxiety.
Multi-causal model - Interaction between physical ( overvigilance to normal body sensations), emotional and social factors.
Approach.
- Therapeutic alliance.
- Same Dr. each time.
- empathy-do not say there is nothing wrong.
- Knowledge reality of distress.
- Ask what they think may be wrong
- Listen
- Offer explanation if possible
- Self help strategies.
- Set aims.
- “Cope as opposed to cure”
- Hx -including psychosocial and occupational aspects.
- Always ask about depression.
- Thorough examination- initially.
- Rationalisation of any meds they may be on.
- If appropriate, investigation. Only once if same symptoms. Limited to symptoms. Help to see as “ruling out a problem” not looking for one.
- Reattribution = Rapport -Broaden agenda. -Link to psychological distress -Allowing patient to link symptoms to psychological state.