title: Multiple symptoms and medically unexplained symptoms--closely related concepts in general practitioners' evaluations. A linked doctor-patient study.
abstract: OBJECTIVE
  Symptoms for which doctors cannot find a clear medical explanation, medically unexplained symptoms (MUS), represent a challenge in medical practice. Recent proposals to define this phenomenon are based on patients' symptom count, without distinguishing between medically explained and unexplained symptoms. We describe how general practitioners (GPs) evaluate multiple and medically unexplained symptoms, and how these dimensions are interconnected. Furthermore, we explore how the number of patient-reported symptoms is associated with the two axes.
  
  
  METHODS
  A multi-centre, doctor-patient-linked cross-sectional study in general practice. GPs rated consecutive patients along two 11 point ordinal scales assessing multiple (Multi-scale) and medically unexplained symptoms (MUS-scale). Patients completed a questionnaire addressing 38 symptoms experienced during the previous week and 866 linked questionnaires were available for analysis.
  
  
  RESULTS
  GPs used the whole range of the scales, rating only a minority of the patients as "0 (not at all)". The two scales were highly correlated (r=0.80), with a quadratically weighted kappa of 0.73, reflecting substantial agreement between the scales. MUS-scores were highest in middle age. There was a tendency that Multi-scores increased with age and that correlations between the scales decreased with age, in both sexes, although partly non-significant. The number of patient-reported symptoms was moderately correlated with the two scales.
  
  
  CONCLUSIONS
  Multisymptomatology captures MUS as a continuous construct to a great degree in GPs' clinical evaluations, although the two cannot be regarded as the same phenomenon. Patient-reported symptoms seem to be a less valid proxy for MUS.
authors: Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, PO BOX 1130, Blindern N-0318 Oslo, Norway. hedda.tschudi-madsen@medisin.uio.no
authors: Hedda
authors: H
authors: Tschudi-Madsen
authors: Mona
authors: M
authors: Kjeldsberg
authors: Bård
authors: B
authors: Natvig
authors: Camilla
authors: C
authors: Ihlebaek
authors: Ingvild
authors: I
authors: Dalen
authors: Jørund
authors: J
authors: Straand
authors: Dag
authors: D
authors: Bruusgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000379:methods; D010817:Physician-Patient Relations; D011569:Psychiatric Status Rating Scales; D013001:Somatoform Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*; D063189:Symptom Assessment / Q000379:methods* / Q000592:standards; D013997:Time Factors; D055815:Young Adult