JRSM >
Volume 96, Number 7 >
Pp. 368-369
Letters |
National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
Email: peterg{at}ion.ucl.ac.uk
A new name may convey new understanding or mask questions that are unresolved. I am not sure where medically unexplained symptoms (MUS), proposed by Dr Page and Professor Wessely (May 2003 JRSM1), fits into those roles.
MUS surely depends upon who is providing the explanation? If I were to go with my somewhat foggy gastroenterological knowledge, based on my Membership examination, and do a busy GI clinic I imagine that I would reach fewer diagnoses than a general physician with an interest in gastroenterology. In turn the generalist might do less well than a specialist gastroenterologist, who might do less well than an upper GI superspecialist, and so on, if one looked at the subset of patients proven to have upper GI problems as the outcome.
As a neurologist interested in headache I see patients labelled with various terms, usually as functional, who have a clearly definable headache syndrome. It is rare in my experience to encounter undiagnosable headache, yet this is often a symptom quoted in such research.2 The unexplained portion seems to have been inadequately explored in the sense that those providing the data were not sufficiently expert to explain it. This brings a question of what is sufficient. We do not accept blood pressure information from faulty devices, so how can such research accept potentially flawed diagnoses?
To assure doctors that 30% of patients are medically unexplained is not very helpful as it implies that there is no diagnosis. To say that a patient has an unexplained problem would require that it has been adequately investigated, or at least a complete history taken by someone sufficiently trained to do so. Research in this area surely requires some standard of measurement of the accuracy of the explanation, or lack of it. Perhaps funds directed to MUS might be directed to better training of doctors in some common clinical problems that are misdiagnosed rather than unexplained.
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