Patients with medically unexplained symptoms (MUS) are one of the most challenging groups for primary care practitioners. There is wide agreement that central problems in managing these patients remain unsolved. Many of these patients are perceived to be difficult, complaining, and to have inflexible attitudes about their symptoms. This presents a clear dilemma, as a good doctor–patient interaction is a fundamental precondition for successful management of these patients. In managing these problems, it is not only in the patient’s behavior, but frequently, also in the physician’s attitude. A compounding problem is that diagnostic systems, treatment guidelines, and many health care regulations in medicine neglect the problem of MUS. The following editorial will highlight some of these problems in more detail.
Conclusion
It is clear that many steps need to be taken to improve the management of patients with MUS. It is not only having the knowledge about the patients and pathophysiological processes, but it is also a modification in the behavioral skills of doctors, and a change in health care system rules that is necessary. Moreover, we have to be aware that stereotypes about patients with MUS are not helpful, as this patient group is very heterogeneous. It is only a small subgroup of patients with MUS who are the really “difficult to treat” patients. Many patients with MUS are open for doctors’ alternative explanations about the origins of their symptoms, and can be motivated to cope with the symptoms. Others have comorbid psychiatric disorders such as depression or panic disorder, which should be treated adequately. These complex issues mean that guidelines for physicians that cover medical decisions (e.g., which investigations and treatments are recommended for which subgroup of patients with MUS) and behavioral recommendations are an important future development in this field.
Acknowledgement
I am grateful to all collaborating general practitioners and internal specialists in Marburg (Germany) who helped me to get insight in their daily work.
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