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If you have been reading medical journals over the last couple of years, you will almost certainly have read about “medically unexplained symptoms”—sometimes abbreviated to MUS. The term was first proposed over 20 years ago, but recently it has grown in popularity and in some places it is taking over from similar and overlapping terms such as somatisation, psychosomatic disorders, frequent consulters, “fat file” patients, and so on. Its use has now spread from researchers and clinicians to managers and health service commissioners. If you work in the UK, someone in your speciality or your area will almost certainly be looking into the possibility of identifying patients with MUS and setting up a dedicated service to relieve their distress and save money for the National Health Service.
At first sight, this way of categorising certain symptoms or patients looks highly attractive. Most clinicians, whatever their field, will readily admit to seeing a proportion of patients for whom it is difficult to assign any diagnosis—or where patients will not accept the diagnosis on offer (most doctors appear to estimate this applies to 15–30% of consultations). Saying that someone has MUS is clearly preferable to calling them a difficult patient or a “heartsink” one. More pertinently, there are now quite a few studies showing that if you separate such people from the bulk of your patients and offer them certain kinds of interventions, they may improve. These interventions include cognitive behaviour therapy (CBT)1 …
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