Management of medically unexplained symptoms

摘要

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 psychogenesis. Other names such as somatisation and somatoform disorder are also being used but imply different definitions. 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. 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.