Open AccessTreating Patients with Medically Unexplained Symptoms in Primary Care
Author(s) -
Smith Robert C.,
Lein Catherine,
Collins Clare,
Lyles Judith S.,
Given Barbara,
Dwamena Francesca C.,
Coffey John,
Hodges Anne Marie,
Gardiner Joseph C.,
Goddeeris John,
Given C. William
Publication year - 2003
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.2003.20815.x
Subject(s) - medicine , primary care , medline , family medicine , intensive care medicine , pediatrics , political science , law
BACKGROUND: There are no proven, comprehensive treatments in primary care for patients with medically unexplained symptoms (MUS) even though these patients have high levels of psychosocial distress, medical disability, costs, and utilization. Despite extensive care, these common patients often become worse. OBJECTIVE: We sought to identify an effective, research‐based treatment that can be conducted by primary care personnel. DESIGN: We used our own experiences and files, consulted with experts, and conducted an extensive review of the literature to identify two things: 1) effective treatments from randomized controlled trials for MUS patients in primary care and in specialty settings; and 2) any type of treatment study in a related area that might inform primary care treatment, for example, depression, provider‐patient relationship. MAIN RESULTS: We developed a multidimensional treatment plan by integrating several areas of the literature: collaborative/stepped care, cognitive‐behavioral treatment, and the provider‐patient relationship. The treatment is designed for primary care personnel (physicians, physician assistants, nurse practitioners) and deployed intensively at the outset; visit intervals are progressively increased as stability and improvement occur. CONCLUSION: Providing a comprehensive treatment plan for chronic, high‐utilizing MUS patients removes one barrier to treating this common problem effectively in primary care by primary care personnel.