Staggeringly, research reveals that as many as one in four GP consultations relates to symptoms which are ‘medically unexplained’. A diagnosis of medically unexplained symptoms (MUS) is made when, despite reasonable investigation, a patient’s persistent physical symptoms do not appear to have an obvious cause.
MUS can affect any part of the body, but symptoms which are commonly reported, either in isolation or in a variety of combinations, include (but are not limited to):
- Aches and pains;
- Blurred vision and other eye complaints;
- Severe headaches;
- Dizziness, fainting or collapsing;
- Constant exhaustion and fatigue, even when inactive.
To be absolutely clear, doctors rarely use MUS to mean ‘all in the mind’, ‘malingerer’, ‘swinging the lead’ or any of the myriad terms suggesting that the patient is not being entirely honest with them. Rather, it may be that the symptoms are recent and still evolving or that the nature of the symptoms means they cannot currently be attributed to a specific condition.
It is also important to remember that some patients who initially receive a diagnosis of MUS are subsequently diagnosed with chronic conditions such as Fibromyalgia (FM), Chronic Fatigue Syndrome (CFS/ME), Functional Neurological Disorder (FND) or Irritable Bowel Syndrome [IBS].
However, it is easy to understand why a diagnosis of MUS is often received by the patient with a sense of frustration, helplessness and a feeling that they are not being taken seriously. Left without a formal diagnosis of a ‘real’ condition, it is common for them to feel stigmatised. If they have a history of anxiety, the label of MUS can heighten feelings of worthlessness and shame. A client once told me that a diagnosis of MUS made him feel as though he had been wrongly convicted of a criminal offence.
Does MUS mean the same as a Somatic Symptom Disorder?
These feelings are not helped by the common misconception that somebody diagnosed with MUS is suffering from a Somatic Symptom Disorder (SSD) (formerly known as a Somatoform Disorder), which is a psychiatric diagnosis. A SSD involves a person having a significant focus on physical symptoms that results in major distress and/or problems functioning.
However, the psychiatric diagnostic ‘bible’, DSM V, cautions that “it is not appropriate to diagnose individuals with a mental disorder solely because a medical cause cannot be demonstrated. Furthermore, whether or not the somatic symptoms are medically explained, the individual would still have to meet the rest of the criteria in order to receive a diagnosis of SSD.”
As GPs encounter MUS so routinely in their practice, it is not surprising that they receive specific training in their diagnosis and management and most are experienced at working with a patients to develop long term coping strategies.