The diagnostic challenges presented by patients with medically unexplained symptoms in general practice

Abstract

Objective. To describe the complexity of somatizing patients’ symptomatology and the difficulties involved in the diagnostic process. Design. Cross-sectional study of patients with medically unexplained symptoms. Setting. Basque Health Service primary care centres in Bizkaia, Spain. Subjects. The study comprised 156 patients selected at random from a list of 468 patients who had presented, over the course of their lives, six or more medically unexplained somatic symptoms for females and four or more for males, identified retrospectively by their practitioners. Main outcome measures. Physicians interviewed these patients using the somatoform symptoms section of the Composite International Diagnostic Interview (CIDI), and the Primary Care Evaluation of Mental Disorders (PRIME-MD). The Medical Outcomes Survey Short Form 36 (SF-36) was filled in at home. Organic diseases whose diagnosis was established during the previous year were included in the study by consulting patients’ medical records. Results. Patients were found to have a median of three medically explained and 12 medically unexplained symptoms. Mental disorders were found in 83% of cases, associated with other morbidity categories in 78%. The predictive value of symptoms was lower than 26% for diagnosing broad disease categories. Conclusions. These results depict an extremely difficult scenario for dichotomous diagnostic strategies aimed at classifying patients’ symptoms as either organic or functional. Rather than struggling to choose one of these hypotheses, it is suggested that both of them should always be addressed concurrently.

• Family physician
• family practice
• general practitioner
• health-related quality of life
• predictive value
• primary healthcare
• somatization
• somatizing patients