Consider the possibility of anxiety or depression—or simply distress

Papers p 767

The efficient use of medical resources is important, so the findings of Reid et al in this issue (p 767)1 are timely, highlighting the previously undocumented number of frequent attenders at secondary care consultations with medically unexplained symptoms. However, this study raises concerns other than economic ones: there appear to be large numbers of patients whose frequent attendance suggests distress that is neither appropriately identified or addressed.

The reasons for frequent attendance by such patients are undoubtedly complex. At least for the first consultation, attendance may reflect the referral patterns of general practitioners. Medically unexplained symptoms are very common in primary care,2 but primary care physicians seem to have considerable discomfort in managing these patients.3 Any patient whose symptoms cannot be explained raises the concern, “What am I missing?” Compounding this unease is the expectation or demand of the patient for a specialist opinion, against a background of increasing …