Intended for healthcare professionals


Management of medically unexplained symptoms

BMJ 2004; 330 doi: (Published 30 December 2004) Cite this as: BMJ 2004;330:4

Very thought provoking

Rosendal, Olesen and Fink have written a wonderfully thought provoking editorial, but I am puzzled by their conclusion that "we should offer the same professional management and quality of care to the many patients with medically unexplained symptoms as we offer to patients with explicable symptoms."1 Might this proposed solution not in fact be a good part of the problem? Certainly there is a growing body of research that doctors' usual ways of communicating with patients, not just those patients with "medically unexplained symptoms", but indeed all patients, have lots of room for measurable improvement. Frankel and Beckman2 for example, found that "in only 17 (23%) of visits was the patient provided the opportunity to complete his or her opening statement of concerns ", being interupted "a mean of 18 seconds after beginning to speak". Moreover, research has found that "perceptions about nontechnical interventions were better predictors of patient satisfaction than perceptions about technical interventions" 3 and that physician encouragement and empathy were related to higher patient satisfaction and reduction in concerns. 4 Based on this and considerable other similar research, one might be tempted to conclude that our approach to caring for patients with medically unexplained symptoms should begin with a careful appraisal and assesment of our approach to caring for all patients. Seen in this light, the challenge of caring for those with medically unexplained symptoms creates a real opportunity for us all to become better clinicians.

1 Rosendal M, Olesen F, Fink P. Management of medically unexplained symptoms. BMJ 2005;330:4-5

2 Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984 Nov;101(5):692-6.

3 Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989 Nov;27(11):1027-35.

4 RC Wasserman, TS Inui, RD Barriatua, WB Carter and P Lippincott. Pediatric clinicians' support for parents makes a difference: an outcome- based analysis of clinician-parent interaction. Pediatrics 1984; 74: 1047- 1053

Competing interests: None declared

Competing interests: No competing interests

02 January 2005
david d derauf
Executive Director Kokua Kalihi Valley Community Health Center
honolulu, hawaii 96817