Medically Unexplained Symptoms in ER Essay Assignment Paper
Medically Unexplained Symptoms in ER Essay Assignment Paper
Medically unexplained physical symptoms (MUPS) are physical symptoms for which no relevant organic pathology can be found. MUPS are very common, comprising up to half of all consultations in primary care and up to one third of those in hospital outpatient clinics.1 Some studies indicate higher prevalence; a landmark study of medical outpatients in North America with new complaints of common symptoms such as chest pain, dyspnoea, dizziness, and headache, found that an organic cause was demonstrated in only 16% of cases.2 Prevalence data for undifferentiated emergency department (ED) populations are very limited. A study of adult patients attending a UK inner city ED found the rate of somatisation and somatoform disorders to be a surprisingly low 3.8%.3 However, this may have arisen due to the application of overly strict diagnostic criteria, allied with a lack of verification of the presence of an organic cause for self‐reported illness. The true ED prevalence probably lies somewhere between this figure and the rates seen in primary care and outpatient clinics.Medically Unexplained Symptoms in ER Research Paper
Although MUPS are a major clinical problem and widely regarded as being difficult to manage,4 sophisticated approaches to management or even recognition of the problem are unusual, especially in hospital medicine. The standard approach is often to rule out all possible physical causes with extensive investigation, and then to either tell the patient that there is nothing wrong or refer them to a psychiatrist. As this approach may take weeks or months, it is not usually possible in a brief ED consultation, even if it were desirable. Moreover, early recognition and communication of the fact that symptoms may not result from organic disease, and early appreciation of the role of psycho social factors, may improve outcomes. Emergency physicians are well placed to employ this approach, with the potential to avoid unnecessary investigation, reduce hospital admissions, and avoid reinforcing the patient’s belief that there is something physically wrong.7
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In all parts of our healthcare system we meet patients presenting with physical symptoms that lack an obvious organic basis. The terms used to describe such symptoms—medically unexplained symptoms or functional somatic symptoms—are purely descriptive and do not imply psycho genesis. Other names such as somatisation and somatoform disorder are also being used but imply different definitions.1–3 Patients with medically unexplained symptoms do not fit into the existing framework of a biomedical model that tends to focus on the exclusion of physical disease. However, the exclusion of relevant physical disease may not in itself cure the patient. He or she may still feel ill and seek medical care. Medically unexplained symptoms therefore represent a clinical problem that must be taken seriously.1–4 General practice has a key role in the management of this clinical problem as at least 20-30% of primary care patients have medically unexplained symptoms. Current evidence indicates that medical care of medically unexplained symptoms should include improvements in three interrelated elements—diagnosis, specific treatment strategies, and communication.Medically Unexplained Symptoms in ER Research Paper
The concept of medically unexplained symptoms comprises a spectrum of disorders ranging from mild transitory illness to chronic disorders with severe disability. Many of the affected patients do not receive a correct diagnosis and undergo numerous fruitless investigations and attempts at treatment. The narrow focus on the somatic aspects of a complex problem may reinforce their concerns about having a physical disease, make them less satisfied with the healthcare system, contribute to the development of chronic disablement, and cause healthcare costs to become excessive.1 3–5 At the same time doctors become frustrated when dealing with medically unexplained symptoms.6
Doctors must have theoretical knowledge about medically unexplained symptoms to be able to diagnose and manage patients presenting with such symptoms appropriately. Diagnosis is not merely the exclusion of serious physical diseases but also the simultaneous consideration of medically unexplained symptoms and classic psychiatric disorders. Such assessment and proper management require good theoretical understanding of the problem, but currently the theoretical and practical training in medically unexplained symptoms is insufficient in most university curriculum’s and postgraduate training program mes for general practitioners
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