title: [Medically unexplained symptoms' care in internal medicine: A paradigm of doctor-patient relationship in situation of uncertainty].
abstract: Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered. Patients with MUS are regularly abused by the doctors, who unwittingly participate in the maintenance of their symptoms and even freeze them, leading to disastrous psychosocial and economic consequences. Yet the doctor-patient relationship is the key to their recovery or, at least, their improvement. The means of a successful patient-centered relationship are not always intuitive but can be learned. It is therefore essential to include SMI in medical school curricula and post-graduate medical education. Finally, if the management of early MUS mainly concerns the family medicine, that of severe MUS, including some fibromyalgia and chronic fatigue syndromes, falls within the scope of the internist doctor, who should be able to deliver a comprehensive care in partnership with the general practitioner and possibly a psychiatrist.
authors.affiliation: Service de médecine interne, hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université Paris Descartes, 15, rue de l'École de Médecine, 75006 Paris, France. Electronic address: brigitte.ranque@aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Ranque
authors.affiliation: Cabinet de médecine générale, 78520 Limay, France; Université Pierre et Marie Curie, 27, rue de Chaligny, 75012 Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Nardon
mesh_terms: D000529:Complementary Therapies / Q000706:statistics & numerical data; D058005:General Practitioners / Q000523:psychology / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards; D000071896:Medically Unexplained Symptoms; D010817:Physician-Patient Relations; D013001:Somatoform Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D035501:Uncertainty
keywords: Doctor-patient relationship; Medically unexplained symptom; Relation médecin-malade; Somatoform disorder; Symptôme médicalement inexpliqué; Trouble somatoforme