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Treating patients with medically unexplained symptoms in primary care

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Abstract

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.

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Authors and Affiliations

  1. Received from the Department of General Internal Medicine, Michigan State University, East Lansing, Mich

    Robert C. Smith MD, ScM, Judith S. Lyles PhD & Francesca C. Dwamena MD

  2. Department of Libraries, Michigan State University, East Lansing, Mich

    John Coffey MS

  3. Department of Epidemiology, Michigan State University, East Lansing, Mich

    Joseph C. Gardiner PhD

  4. Department of Economics, Michigan State University, East Lansing, Mich

    John Goddeeris PhD

  5. Department of Family Practice, Michigan State University, East Lansing, Mich

    C. William Given PhD

  6. Department of College of Nursing, Michigan State University, East Lansing, Mich

    Catherine Lein MS, FNP, Clare Collins RN, PhD & Barbara Given RN, PhD

Authors
  1. Robert C. Smith MD, ScM
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  2. Catherine Lein MS, FNP
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  3. Clare Collins RN, PhD
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  4. Judith S. Lyles PhD
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  5. Barbara Given RN, PhD
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  6. Francesca C. Dwamena MD
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  7. John Coffey MS
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  8. AnneMarie Hodges MS
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  9. Joseph C. Gardiner PhD
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  10. John Goddeeris PhD
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  11. C. William Given PhD
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Corresponding author

Correspondence to Robert C. Smith MD, ScM.

Additional information

This work was supported by National Institute of Mental Health grant MH57099.

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Smith, R.C., Lein, C., Collins, C. et al. Treating patients with medically unexplained symptoms in primary care. J GEN INTERN MED 18, 478–489 (2003). https://doi.org/10.1046/j.1525-1497.2003.20815.x

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