title: What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study.
abstract: Context Medically unexplained physical symptoms (MUPS) are frequently encountered in family medicine, and lead to disability, discomfort, medicalisation, iatrogenesis and economic costs. They cause professionals to feel insecure and frustrated and patients to feel dissatisfied and misunderstood. Doctors seek answers for rather than with the patient. Objectives This study aimed to explore patients' explanations of the medically unexplained physical symptoms that they were experiencing by eliciting their own explanations for their complaints, their associated fears, their expectations of the consultation, changes in their ideas of causality, and the therapeutic approach that they considered would be useful. Methodology A qualitative analysis was under-taken of interviews with 15 patients with MUPS in a family medicine unit, 6 months after diagnosis. Results Experience is crucial in construction of the meaning of symptoms and illness behaviour. Many patients identify psychosocial causes under-lying their suffering. These patients received more medication and fewer requests for diagnostic examinations than they had expected. Normalisation is a common behaviour in the clinical approach. Normalisation without explanation can be effective if an effective therapeutic relationship exists that may dispense with the need for words. Listening is the procedure most valued by patients. Diagnostic tests may denote interest in patients' problems. The clinician's flexibility should allow adaptation to the patient's phases of acceptance of the significance of their physical, emotional and social problems. Conclusion Patients with MUPS have explanations and fears associated with their complaints. The patient comes to the consultation not because of the symptom, but because of what he or she thinks about the symptom. The therapeutic relationship, therapeutic listening, and flexibility should be the basis for approaching patients with MUPS. Patients do not always expect medication, although it is what they most often receive. Diagnostic tests, although used sparingly, can be a way to maintain and build a relationship. Drugs and tests can be a ritual statement of clinical interest in the patient and their symptoms.
authors.affiliation: Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Nunes
authors.affiliation: Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ventura
authors.affiliation: Department of Mental Health, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Encarnação
authors.affiliation: Head of Medical Education Department, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: Patrícia Rosado
authors.initials: PR
authors.lastname: Pinto
authors.affiliation: Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Santos
keywords: communication; physician-patient relationship; primary healthcare; qualitative research; somatoform disorders