Silos of Silence, Stress, and Suffering: Patient and Physician Experiences of MUPS and Diagnostic Uncertainty

Abstract

Ours is a qualitative investigation that interviews practitioners and patients about the phenomenon of MUPS (medically unexplained physical symptoms)–i.e., the context of lacking clear diagnostic and treatment options and the experience of being “not yet diagnosed.” With regard to practitioners, since current diagnostic models in medical practice do not adequately account for patient symptoms that cannot be classified (Lolas 1985; Salmon 2007), our study explores how physicians respond to uncertainty, how they communicate ambiguity to colleagues and to patients, and which resources they opt to employ in relating to patients and addressing treatment options. With regard to patients, as societal views of allopathic medicine are of a practice that is highly technological and all-knowing, few understand that physicians sometimes cannot fathom patients’ complaints. By conversing with MUPS patients, our project aims to reveal the agencies of persons who live with baffling symptomology—their searching, reasoning, communication and coping methods. Moreover, an ethics-based framework informs our conversations. Considerations of nonmaleficence and beneficence, deontological autonomy, consent and truth-telling, as well as feminist relational ethics all orbit our discussions. it seems as though physicians and patients share more than they realize when confronting diagnostic uncertainty and MUPS. While both cohorts are silent, stressed, and isolated by the experience of either treating or living with unexplained physical symptoms, they do so in separate silos of understanding and experience. A phenomenological approach reveals how very important it is to pay attention to people's experiences of health care from both sides of the gurney.

Keywords:

• Neuroethics
• Professional Ethics

Notes

This project is entitled “Best Ethical Practices in Managing Uncertainty in Medical Diagnosis: An Investigation of Ethical Principles Applied to Decision Making” and has been awarded a Canadian Health Institute Research, Ethics Catalyst Grant CDN $100,000.