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Encouraging clinicians to work effectively with people with medically unexplained symptoms - is a change in underlying attitudes required?

Marta J Buszewicz


Medically unexplained symptoms are defined as physical symptoms for which there is no clear diagnosis of organic pathology, including after relevant investigations. Several other terms are also used to describe such symptoms and will be briefly described, although none is ideal. The present paper summarizes the current research, illustrating how patients consulting clinicians in both primary and secondary care often present with symptoms which, while undoubtedly distressing for the patient, do not link with any clear organic pathology. This raises difficult issues for clinicians in terms of how much they should investigate and how to manage the patient’s problems in a way which will be helpful and mean they will feel their symptoms have been appropriately recognised and addressed. Failure to do this can lead to many negative consequences, including a breakdown in trust between patients and clinicians, over-investigation or inappropriate treatments, a loss of normal function for the patient and significant costs to the health service and economy.

Despite this, the evidence is that doctors receive very little if any training about how to manage such symptoms at either the undergraduate or postgraduate level. This paper will focus on the attitudes of both junior and more senior doctors across a range of specialities to working with people with unexplained symptoms and how these may affect their management. The implications for clinical practice and recommendations for future training will be discussed and in particular the need to consider the psychosocial as well as the biomedical aspects of patients’ presentations from the outset.


medically unexplained symptoms; doctor's attitudes; education and training

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Stone, J., Wojcik, W., Durrance, D., Carson, A., Lewis, S., MacKenzie, L., Warlow, C.P. & Sharpe, M. (2002). What should we say to patients with symptoms unexplained by disease? The “number needed to offend”. British Medical Journal 325, 21-28.

Burton, C. (2003). Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). British Journal of General Practice 53, 231-239.

De Waal, M.W.M., Arnold, I.A., Eekhof, J.A.H. & Van Hemert, A.M. (2004). Somatoform disorders in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders. British Journal of Psychiatry 184 (6) 470-476.

Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129-136.

Kroenke, K. & Mangelsdorff, A.D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. American Journal of Medicine 86 (3) 262-266.

Peveler, R., Kilkenny, L. & Kinmonth, A-L. (1997). Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. Journal of Psychosomatic Research 42 (3) 245-252.

Haller, H., Cramer, H., Lauche, R. & Dobos, G. (2015). Somatoform Disorders and Medically Unexplained Symptoms in Primary Care: A Systematic Review and Meta-analysis of Prevalence. Deutsches Ärzteblatt International 112 (16) 279-287.

Nimnuan, C., Hotopf, M. & Wessely, S. (2001). Medically unexplained symptoms: an epidemiological study in seven specialities. Journal of Psychosomatic Research 51, 361-367.

Bermingham, S., Cohen, A., Hague, J. & Parsonage, A. (2010). The cost of somatisation among the working-age population in England for the year 2008–2009. Mental Health in Family Medicine 7 (2) 71-84.

Rosendal, M., Olesen, F. & Fink, P. (2005). Management of medically unexplained symptoms. British Medical Journal 330 (7481) 4-5.

Howman, M., Walters, K., Rosenthal, J., Good, M. & Buszewicz, M. (2012). Teaching about medically unexplained symptoms at medical schools in the United Kingdom. Medical Teacher 34 (4) 327-329.

Yon, K., Habermann, S., Rosenthal, J., Walters, K., Nettleton, S., Warner, A., Lamahewa, K. & Buszewicz, M. (2017). Improving teaching about medically unexplained symptoms for newly-qualified doctors in the UK: findings from a questionnaire survey and expert workshop. BMJ Open Available at: Accessed 24 July 2017.

Yon, K., Nettleton, S., Walters, K., Lamahewa, K. & Buszewicz, M. (2015). Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study. BMJ Open available at: (accessed 07.04.2017)

Howman, M., Walters, K., Rosenthal, J., Ajjawi, R. & Buszewicz, M. (2016). "You kind of want to fix it don't you?" Exploring general practice trainees' experiences of managing patients with medically unexplained symptoms. BMC Medical Education 16, 27.

Warner, A., Walters, K., Lamahewa, K. & Buszewicz, M. (2017). How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians. Journal of the Royal Society of Medicine 110 (2) 65-72.

Salmon, P., Ring, A., Dowrick, C.F. & Humphris, G.M. (2005). What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurised? Journal of Psychosomatic Research 59, 255-260.

Dowrick, C.F., Ring, A., Humphris, G.M. & Salmon, P. (2004). Normalisation of unexplained symptoms by general practitioners: a functional typology. British Journal of General Practice 54 (500) 165-170.

Weiland, A., Blankenstein, A.H., Van Saase, J.L.C.M., Van der Molen, H.T., Jacobs, M.E., Abels, D.C., Kose, N., Van Dulmen, S., Vernhour, R.M. & Arends, L.R. (2015). Training medical specialists to communicate better with patients with medically unexplained physical symptoms (MUPS). A randomized, controlled trial. PLoS ONE 10, e0138342.

Rief, W., Martin, A., Rauh, E., Zech, T. & Bender, A. (2006). Evaluation of general practitioners’ training: how to manage patients with unexplained physical symptoms. Psychosomatics 47, 304-311.

Salmon, P., Peters, S. & Stanley, I. (1999). Patients’ perceptions of medical explanations for somatisation disorders: qualitative analysis. British Medical Journal 318 (7180) 372-376. (last accessed 11.04.2017).

Joint Commissioning Panel for Mental Health. (2017). Guidance for commissioners of services for people with medically unexplained symptoms. Available at: (last accessed 11.04.2017).



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