Medically unexplained symptoms in secondary care

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7309.397 (Published 18 August 2001) Cite this as: BMJ 2001;323:397

Doctors in secondary care should respect general practitioners

  1. John McCormack, general practice trainee (doctorjohn@eircom.net)
  1. Department of Psychiatry, University College Hospital, Galway, Republic of Ireland
  2. Morley Acupuncture Clinic and Complementary Therapy Centre, Morley, Leeds LS27 8EG

    EDITOR—The patronising tone adopted by Turner towards primary care referrals in her editorial is quite disconcerting.1 As the original article by Reid et al refers to medically unexplained symptoms in secondary care it is unfair to infer that this has a bearing on the primary care physician's competence or referral pattern.2 The “bread and butter” of primary care is dealing with symptoms that do not fit the disease model. Uncertainty is a real commodity. If you can deal with it you will thrive; if you cannot you should opt to work in secondary care, where you are more likely to reinforce what you already know by performing often unnecessary, expensive, and invasive tests. With the move to increased subspecialisation there is a greater tendency to propagate the medical bandwagon—for example, “All your tests are negative, Mrs Jones, therefore you have no oro/neuro/endocrino/otorhinolaryngo/gastro/respiritro/rheumato/ophthalalmolo /cardio/reno/physio/psycho-logical problem.” Medicine is much more than positive or negative investigations, and it seems that the only specialty that consistently recognises this is general practice.

    When a specialist in secondary care has exhausted his or her efforts to explain a patient's symptoms the patient should be re-referred to the general practitioner with the documentation, “I do not know what is wrong with your patient.” Now that doctors in secondary care are realising that many medical consultations bear no relation to the disease model, perhaps those …

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