Medically Unexplained Symptoms: How misunderstanding leads to mistakes
4th December 2018
By Lily Hopkins
The term Medically Unexplained Symptoms, or MUS, refers to persistent bodily complaints, such as pain, seizures and fatigue, which have no identifiable physical explanation. These symptoms are more common than you may think, with a recent publication by the Joint Commissioning Panel for Mental Health finding that an estimated 52% of patients who access outpatient services are thought to have MUS. Whilst these patients make up a large proportion of NHS users, accounting for around 10% of total NHS spending for the working age population in the UK, MUS remains chronically misunderstood. Overall, services in this country for MUS remain widely ineffective and lacking, apart from a few specialised sources. Consequently, outcomes for MUS patients are often poor as appropriate services and treatments are rarely available.
But where does this misunderstanding arise? A common misconception surrounding MUS is that these patients are ‘making it up’ or ‘exaggerating symptoms’. This is generally incorrect; MUS can affect anyone no matter their age, gender, or race and is usually not associated with conscious lying or exaggeration. However, this view can lead to patients experiencing stress, distress and anxiety when faced with a diagnosis of MUS which can have a negative effect on their wellbeing. Additionally, research has shown that due to a lack of specific training, despite their best intentions, many doctors hold a negative view about the causes and management of patients with MUS (Shattock et al, 2013) which can lead to patients feeling like they are not believed by those caring for them. Furthermore, a lack of understanding may cause doctors to pursue inappropriate medical tests for MUS patients, sometimes involving invasive procedures which can lead to more stress and anxiety. On top of this, patients are not only the ones who experience negative outcomes when dealing with MUS; GPs also report feeling powerless and stressed when dealing with MUS patients (Edwards et al, 2010), and have difficulties in making diagnoses, meaning that patients do not receive the correct help early enough.
An issue here is that physiological and psychological services for these patients remain unconnected. Currently the services for patients involve either psychological treatment or physiological investigation, however research has shown that MUS patients require both emotional support and an appropriate physiological component focusing on bodily function in order to produce positive outcomes. Unfortunately, GPs are not trained specifically for these cases and as they are the front-line service, it is only when all physiological explanations have been ruled out that psychological services become involved. Therefore, by the time that patients access MUS specific care, it is often too late in their journey to produce positive outcomes.
To target this, the healthcare system for MUS needs to move towards a bio-psychosocial approach, with physiological and psychological treatments accessible from an early stage in a patient’s care journey. Training for front-line NHS staff must be implemented to avoid negative misconceptions about MUS and unnecessary use of specialist services which can lead to distressing outcomes for both staff and patients. Overall, misunderstanding surrounding MUS is driving mistakes in their care, and must be targeted in order to increase these patient’s recovery chances.