BMJ  2004;328:1319 (29 May), doi:10.1136/bmj.328.7451.1319-a

Letter

Do patients with unexplained physical symptoms pressurise GPs for somatic treatment?

Sorting the wheat from the chaff

The first 150 words of the full text of this article appear below.

EDITOR—The qualitative study by Ring et al asks whether patients with unexplained physical symptoms pressurise their general practitioners for somatic treatment.1 It seems to be blaming the doctors for not managing the patients properly. As others have pointed out on bmj.com,2 management is not easy.

I agree that many of these patients may have psychiatric illness and somatisation disorders, but some do not. At what point can medically unexplained symptoms be ignored and not investigated again?

I can think of several "difficult" patients who had extensive investigations over prolonged periods before their slowly developing rare pathology was diagnosed. One was told by two eminent orthopaedic surgeons that the peculiar back pain did not have an organic cause until chronic staphylococcal discitis was diagnosed. Another patient had a retropancreatic abscess diagnosed after several years of complaints of abdominal pain, with normal laboratory and scan results. Retroperitoneal fibrosis, Lyme disease, . . . [Full text of this article]

Trefor J Roscoe, general practitioner for 20 years

Sothall Medical Centre, Sheffield S20 5JX Trefor@nhs.net


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Relevant Article

Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study
Adele Ring, Christopher Dowrick, Gerry Humphris, and Peter Salmon
BMJ 2004 328: 1057. [Abstract] [Full Text] [PDF]

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