Do patients with unexplained physical symptoms pressurise GPs for somatic treatment?BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7451.1319-a (Published 27 May 2004) Cite this as: BMJ 2004;328:1319
Sorting the wheat from the chaff
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, autoimmune disorders, thyroid disease, diabetes, and many others can present in such an insidious fashion that the diagnosis can be missed for months or even years.
General practice is an art not a science with many patients. You have to keep an open mind or you may miss something treatable.
Competing interests None declared.