Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study

doi:10.1136/bmj.322.7289.767

BMJ 2001;322:767 ( 31 March )

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Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study

Steven Reid, clinical research fellow, ^a Simon Wessely, professor of epidemiological and liaison psychiatry, ^a Tim Crayford, consultant in public health medicine, ^b Matthew Hotopf, clinical senior lecturer. ^a

^a Academic Department of Psychological Medicine, Guy's, King's College, and St Thomas's Hospital School of Medicine and Institute of Psychiatry, London SE5 8AZ, ^b Bromley Health Authority, Bromley BR2 7EH

Correspondence to: S Reid steve.reid{at}kcl.ac.uk

Objective: To estimate the prevalence of medically unexplainedsymptoms in patients who most frequently attend outpatientservices.
Design: Retrospective cohort study over three yearswith review of casenotes.
Setting: Secondary care services in the South Thames(West) NHSregion.
Participants: Outpatient attenders with new appointmentsin1993.
Main outcome measures: Number of outpatient appointments, and numberof consultation episodes for medically unexplainedconditions.
Results: Medical records of 361 of 400 sampled frequentattenders were examined, and 971 consultation episodes were recorded.Ninety seven (27%) had one or more consultation episodes in whichthe condition was medically unexplained; 208 (21%) of the 971consultation episodes were medically unexplained. Abdominal pain,chest pain, headache, and back pain were commonly found to bemedicallyunexplained.
Conclusions: Medically unexplained symptoms present inmost hospital specialties and account for a considerable proportionof consultations by frequent attenders in secondarycare.

What is already known on this topic
Frequent attenders in all medical settings account for a disproportionate amount of healthcare resources

In primary care, frequent attenders commonly present with symptoms that remain medically unexplained

What this study adds
Medically unexplained symptoms are also common among frequent attenders in secondary care and present in most specialties

Symptoms that are particularly likely to remain unexplained in this group include gastrointestinal complaints, back pain, and headache

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