GP Sceptics podcast 11: Medically Unexplained Symptoms

GP Sceptics

Unexplained, by Kat Ritchie

https://drjustincoleman.files.wordpress.com/2017/08/pod11_timo_completel1.mp3

Medically unexplained symptoms (MUS) are physical symptoms not sufficiently explained by an underlying medical condition after adequate examination and investigation, over a period of time (usually defined in months, rather than weeks).

GPs face patients in this situation regularly, and not surprisingly, find it difficult to deal with. Our training focuses on reaching elusive diagnoses through the scientific method of testing and discarding hypotheses until – eureka! – we land upon the right one.

But what happens when, like the stockade, that eureka fails us?

And if you think that’s frustrating for the diagnostician, try being the patient!

In this podcast, we interview a GP from the Netherlands who is at the forefront of this field. Dr Tim Olde Hartman was the lead author of the MUS guidelines (pdf) developed for the Dutch College of General Practitioners.

The guide’s popularity soon made it clear that this is a universal problem around the world, nowhere more apparent than in general practice. When a series of specialist appointments have failed to diagnose a medical cause for a persistent symptom, the advice is inevitably “go back and see your GP”.

This podcast is for those GPs.

Liz was lucky enough to meet Tim Olde Hartman during a sabbatical to the Netherlands, where she teed up this podcast interview.

In Liz’s Special Source segment, we discuss the wonderful HANDI guide – the RACGP Handbook of Non-Drug Interventions.

Justin’s factoid “Null but not void” looks at the media’s responsibility to write articles about negative findings, not just positive ones.

Enjoy!

References:

Dr Tim Olde Hartman’s profile at Radboud Institute for Health Sciences

Olde Hartman T et al. NHG Guideline on Medically Unexplained Symptoms (MUS) Huisarts Wet 2013;56(5):222-30.

den Boeft N et al. How should we manage adults with persistent unexplained physical symptoms? BMJ 2017;356:j268

RACGP The Handbook of Non-Drug interventions (HANDI): making effective non-drug treatments more visible and easier to use.

Jaklevic M Null but not void: Why health journalists need to stop ignoring negative studies Health News Review, March 2017

Interesting reading:

van Dessel N et al. Cochrane Systematic Review: Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults