Intended for healthcare professionals

Practice Uncertainties

How should we manage adults with persistent unexplained physical symptoms?

BMJ 2017; 356 doi: (Published 08 February 2017) Cite this as: BMJ 2017;356:j268

Chinese translation


New systemic analysis - important clues to aetiology of 'medically unexplained'...

Newly published (October 2018) research is revealing alarming evidence confirming what patients have been trying for years to flag up - as previously discussed in this collection of rapid reponses..

This new research can be accessed via the website of the All Party Political Group for Prescribed Drug Dependence (APPG-PDD) :

This new evidence is currently gaining wide publicity and press attention. I am co-author of one of these reports: 'The Patient Voice: an analysis of personal accounts of prescribed drug dependence and withdrawal submitted to petitions in Scotland and Wales." . The aetiology of the huge burden of 'medically unexplained symptoms' experienced can be clearly seen in the published patient testimony, analysed in this report. The systems analysis 'Lean thinking' framework clearly identifies the systemic 'failure points'. These common failures are resulting in consequences where patients' health is being (presumably unintentionally) worsened by prescribed 'treatment', and over the longer term. "For some of the responders all consultations, no matter what the problem, are now being seen through the root cause in anxiety/depression because of their history with these medications, sometimes when that wasn't even the reason for being prescribed the drug in the first place".

There is an explanation - for a great many cases of MUS. Patients' experience must be believed and the root causes must be addressed in order to prevent further harm to more patients.

Already harmed patients (the unsuspecting guinea-pigs) must be afforded all possible support, recognition and recompense for the harm they have suffered and are suffering. This diagnosis of 'medically unexplained' is adding furthur insult to very severe unacknowledged iatrogenic injury. Indeed, it has resulted in complete breakdown of the 'Doctor-patient' relationship - as can be clearly seen in our 'Patient Voice' report(s) when patients are not believed.

The Herald Scotland has been following our journey and reported extensivley on 14 October

The Scottish and Welsh Petitons continue to gather further evidence and the Scottish Petition is on the agenda for Public Petition Committee 5th consideration at Holyrood on 25 October 2018.

Competing interests: No competing interests

20 October 2018
Marion Brown
Psychotherapist and Mediator (Independent)