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.