Blog: Improving care for people with Medically Unexplained Symptoms

AndyPR

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Guiding the lifeboats to safer waters.
Not a recommendation.
As a newly qualified General Practitioner, I struggled to manage people who I thought might have medically unexplained symptoms (MUS). What would I say to the patient? Who could I refer the patient to? What could I do to support the patient, and maybe even try to improve their situation?

So, what are medically unexplained symptoms?

MUS actually accounts for a considerably high proportion of NHS activity, with approximately 10% of total NHS expenditure being spent on services for the working age population in England with medically unexplained symptoms.
MUS refers to the persistent bodily complaints, whereby adequate examination and investigation does not reveal sufficiently explanatory structural or other specified pathology. MUS are common, with a spectrum of severity, and patients are found in all areas of the healthcare system - Primary Care, the Emergency Department and Specialist Out-patient clinics. Symptoms can often include pain (muscle, headache, pelvic, facial, chest), fatigue, dizziness, shortness of breath, and may also be presented in combination.

What impact do Medically Unexplained Symptoms have on GPs?

Extensive literature looks into the impact on clinicians managing MUS, showing that family doctors feel less satisfied caring for patients with persistent MUS rather than patients with psychological problems. GPs have reported that they often find it stressful to work with patients with MUS, going on to describe a sense of 'powerlessness' during the consultation. These negative emotions can then go on to influence their professional judgement.
During some of my earlier research, conducted with medical students, GPs were interviewed about their experiences of managing patients suffering from MUS. One particularly notable quite illustrated the impact that patients with MUS has on GPs;
"Some make your stomach churn when they come in...very nervous. They make it very clear they are taking charge; and they do, they take charge, and there is nothing you can do". (GP quoted in the Wileman Paper)
http://primarycarekeele.blogspot.co.uk/2017/02/mus-guidelines.html

Comments are open, only one comment so far but a very good one.
 

lilpink

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Yes the solitary comment is good. I tried to add another but it didn't make it through moderation. We need to keep this in the front of our minds... the way in which MUPS is being rolled out and the derogatory comments used to enthuse members of the medical profession and service providers alike is very worrying.

I won't add more to this thread as I appreciate it's already covered at my post elsewhere, but this isn't going away.
 

Cheshire

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A podcast in the same vein (GP sceptics, what a joke....):
https://drjustincoleman.com/2017/08/10/gpsceptics-pod11-medically-unexplained-symptoms/

Presentation:
Medically unexplained symptoms (MUS) are physical symptoms not sufficiently explained by an underlying medical condition after adequate examination and investigation, over a period of time (usually defined in months, rather than weeks).

GPs face patients in this situation regularly, and not surprisingly, find it difficult to deal with. Our training focuses on reaching elusive diagnoses through the scientific method of testing and discarding hypotheses until – eureka! – we land upon the right one.

But what happens when, like the stockade, that eureka fails us?

And if you think that’s frustrating for the diagnostician, try being the patient!

In this podcast, we interview a GP from the Netherlands who is at the forefront of this field. Dr Tim Olde Hartman was the lead author of the MUS guidelines (pdf) developed for the Dutch College of General Practitioners.

The guide’s popularity soon made it clear that this is a universal problem around the world, nowhere more apparent than in general practice. When a series of specialist appointments have failed to diagnose a medical cause for a persistent symptom, the advice is inevitably “go back and see your GP”.

This podcast is for those GPs.


Enjoy!
 
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Chrisb

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They have given the game away:

"As a GP what can I do?

..........I led the development of a number of fact sheets which aim to support GPs in their daily encounters with people with mental health problems. One of these fact sheets focuses on MUS, which makes valuable suggestions to support you, as a GP, in the identification and management of patients suffering with MUS."

Clearly you only need read the fact sheet if you have a patient with a mental health problem.

The fact sheet in the "Mental Health Toolkit" for "Medically unexplained Symptoms guidance" is introduced by the statement "The following tools may be used for recognising, diagnosing and helping patients with a mental illness".

I find it hard to decide whether there is a general lack of competence, or whether it is merely an absence of the skills necessary for drafting complex documents.
 

Cheshire

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Is it tricky for GP to stop investigating?
It seems that GP know very fast in their consultation or shortly after the start of the consultation if a patient is presenting with MUS. So I think GPs are very good in listening to the story of the patient. They are very quick in knowing that it might be MUS.
Yeah, relying on your prejudice really is the best management of all. :bang-head:
That could have perfectly happened with ER doctors
A young mother suffering a fatal reaction to painkillers was accused of "faking it" for "attention" by paramedics as she lay dying, an inquest heard.
http://www.telegraph.co.uk/news/201...oms-attention-inquest/?WT.mc_id=tmgoff_fb_tmg
 

lilpink

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lilpink

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Just to draw people’s attention to the radio programme - https://www.talkradioeurope.com/on-demand/ that aired on Wednesday 23rd May – in the 20.00 to 21.00 and 21.00 and 22.00 slots (8pm to 10pm) where there is an excellent discussion about the harms that drugs can cause, especially antidepressants (in particular SSRIs) and benzodiazepines.

In the first hour there is a long interview with David Healy, ending with a clip from a patient who is calling for a public inquiry, and in the second hour we hear from several patients who have suffered and from Marion Brown who is a psychotherapist and the petitioner for this petition to the Scottish Parliament that aims to highlight the harms caused by prescribed drug dependence and withdrawal.- http://www.parliament.scot/GettingInvolved/Petitions/PE01651 . NB If you have been harmed by drugs it is apparently possible for any individual from anywhere (you don’t have to live in Scotland but it mustn’t be from an organization) to add to this petition by emailing petitions@parliament.scot quoting - PEO1651 – in the subject heading.


One of the points raised in the radio programme is that patients suffering from drug side-effects and withdrawal effects are likely to be told that they have MUS or ‘medically unexplained symptoms’ and are then regarded as being mentally ill. They are one group of many groups of patients who are suffering as a result of the MUS label that is being imposed on them. Wouldn’t it be good if all of these groups, ME included, could join together and support each other to help overturn this MUS model?
 

lilpink

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Following on from #8, the excellent radio discussion about the harms that drugs can cause, (especially antidepressants and benzodiazepines ), can also be accessed via this link - http://www.jfmoore.co.uk/tre.html

In relation to petitions, in addition to the Scottish petition there was also a Welsh petition that took some 'patient experience' evidence. Here is a link to the full 'Meetings' information about this petition - http://www.senedd.assembly.wales/ieIssueDetails.aspx?IId=19952&Opt=3 which includes that evidence and may be of particular interest to people living in Wales who have had problems with drugs that they've been given