According to Mary Lowth, in her article, “Medically Unexplained Symptoms,” there are “up to a fifth of primary health care consultations [that] fit in the category of MUS.” The core purpose of primary healthcare physicians is to evaluate a patient’s symptoms and determine a diagnosis with the help of using physical data and refer patients to specialists in the area of need. General physicians are trained to diagnosis common medical illness (i.e. cold, flu, etc.) using the diagnostic algorithm taught in medical school; however, when physicians use the diagnostic algorithm to diagnose medically unexplained symptoms (MUS) they have a difficult time because these symptoms don’t fall into a perfect category. Additionally, Lowth defines medically unexplained symptoms (MUS) as, “symptoms which don’t correspond to visible or structural physical abnormalities. MUS therefore covers conditions as diverse as irritable bowel syndrome (IBS) and chronic fatigue.” In the article, “Lost in a System Where Doctors Don’t Want to Listen,” by Benjamin H. Natelson, he states, “Studies have shown that in more than 50 percent of cases, patient complaints don’t have any diagnosable medical cause that can be determined by careful laboratory testing.” Meaning, when physicians lack physical and visible evidence they can’t give an accurate diagnosis or treatment for the patient’s symptoms. When physicians have limited medical options for patients with MUS, as a result, this can damage the relationship between a physician and a patient with MUS; however, by implementing personalized healthcare and teaching physicians how to determine MUS, as well as how to effectively communicate MUS to patients, will improve the doctor-patient relationship needed to manage MUS.

In the article, “The Treatment of Patients with Medically Unexplained Symptoms in Primary Care: A Review of the Literature,” published by Mental Health in Family Medicine, they acknowledge that “the treatment of patients with MUS can be both challenging and frustrating for busy GPs and their concerned patients.” This addresses that doctors and patients both have difficulties dealing with MUS. To illustrate, doctors can’t give an accurate diagnosis or treatment for patients with MUS because they lack knowledge, understanding, and evidence. In the article, “‘It’s incredible how much I’ve had to fight.’ Negotiating Medical Uncertainty in Clinical Encounters,” by Olaug S. Lian and Catherine Robson, they illustrate the physician’s perspective when encountering MUS, “their ability to identify, explain and treat patients’ ailments is constrained by an uncertain biomedical foundation, they often feel powerless, in adequate, dissatisfied, frustrated and anxious.” According to Mary Lowth, in her article “Medically Unexplained Symptoms,” she states, “Some symptoms are unexplained because of deficiencies in our medical knowledge and medical science has a long history of not being right.” When a doctor mistreats or mishandles a case of MUS by dismissing, disbelieving, stereotyping, normalizing or discrediting the patient’s symptoms and experiences of pain it creates a poor doctor-patient relationship. Lowth acknowledges that the “patients’ frustration at our [doctors] apparent lack of ability, or even our [doctors] lack of interest or unwillingness to help. This easily leads to dysfunctional and unhappy consultations and can make progress difficult to achieve.” Additionally, Lian and Robson illustrate the patient’s perspective when dealing with MUS, they stated “For patients, experiences of uncertainty can increase psychological distress, intensify sensitivity to pain and result in poorer health reduced quality of life and diminished confidence.” In primary healthcare, having a good doctor-patient relationship is crucial to eliminating stress for the patient. If doctors demonstrated support and understanding towards the patient’s symptoms, then that would increase the progress towards managing the symptoms.

The current primary healthcare system fails to provide beneficial healthcare to patients with MUS because the physicians are limited on the amount of time to diagnosis MUS and money to run further tests. According to Nitesh V. Chawla and Darcy A. Davis, in their article, “Bringing Big Data to Personalized Healthcare: A Patient-Centered Framework,” they acknowledge that “it’s impossible for an individual physician to fully analyze it (in real time) at the time of patient interaction.” Benjamin H. Natelson also stated, “When all the tests are normal and time has run out, the doctor will conclude a visit.” Additionally, the economic cost of tests limit physicians from doing additional tests especially without sufficient evidence. The article published by Mental Health in Family Medicine, they found that “MUS patients generate higher healthcare costs as a result of increased use of diagnostic tests, and have longer visits to doctors when compared to other patients.”

19_future-of-personalized-medicine

In order to manage and treat MUS, it requires a solid doctor-patient relationship; therefore, implementing personalized healthcare in primary care would use patient-center methods that are tailored to the individual patient. In the article, “Bring Big Data to Personalized Healthcare: A Patient-Centered Framework,” defines personalize healthcare as “a patient-centered model, patients actively participate in their own care and receive services focused on individual needs and preferences, informed by advice and oversight from their healthcare providers,” and “creates a personalized disease risk profile, as well as a disease management plan and wellness plan for an individual.”  In a personalized healthcare, doctors would enter a patient’s medical history and other patients’ medical history into a data system called Collaborative Assessment and Recommendation Engine (CARE) used to predict the patient’s risk of getting a certain disease. Personalized healthcare is beneficial to patients with MUS because it implements patient-centered medicine into primary care offices, allowing doctors with more resources to help ease diagnosing difficult illnesses, such as MUS. According to Mental Health in Family Medicine, they stated, “No single approach will effectively treat all patients with MUS in primary care,” which indicates that every patient with MUS has different symptoms; therefore, the patient requires an individual plan of care. Most importantly, personalized healthcare will improve doctor-patient relationships because it prevents doctors from overlooking certain diseases or illnesses that an individual might be at risk for and encourages discussions to take place between doctors and patients. In the article, “Medically Unexplained Symptoms,” by Margaret L. Isaac and Douglas S. Paauw, they stated, “the physician-patient relationship, still in its rightful place at the heart of the practice of medicine, lies at the center of effective treatment of patients with MUS,” because it requires the patient and doctor to collaborate together in order to manage the MUS properly. Personalized healthcare is the ideal method to improve the relationship between physicians and patients with MUS; however, in the meantime there are additional solutions to implement starting in medical schools.

Another possible solution is for medical schools to teach students how to recognize MUS and teach specific communication skills for cases of MUS. If medical schools educated MUS more in depth, then it would allow future physicians to recognize signs of MUS and would avoid damaging the doctor-patient relationship. In the article, “Medically Unexplained Symptoms and the Problem of Power in the Primary Care Consultation: A Qualitative Study,” published by Oxford University Press, their research concluded, “the need for more training for GPs in the area of managing this difficult group of patients [MUS patients]. GPs felt that they should continue to be managed in primary care, but they needed support in managing the negative feelings and frustrations that currently coping with these patients induces.” In other words, the general physicians from this study suggested that doctors need more resources and education in MUS. In the article “Medically Unexplained Symptoms,” by Mary Lowth gives guidelines for ways to diagnosis MUS and good consultation skills general physicians should implement in order to create a positive doctor-patient relationship. Lastly, medical schools need to encourage the importance to effectively communicate to patients with MUS. In the article “The Treatment of Patients with MUS in Primary Care: A Review of the Literature,” by Radcliffe Publishing, a study showed that “validation and empathy from GPs toward their patients is associate with higher patient ratings of interpersonal care, particularly when there is ambiguity in the patient presentation.” General physicians who show validation and empathy towards their patients with MUS, have a better doctor-patient relationship because the patient’s symptoms aren’t being ignored by their physician. Patients with MUS strive to have a physician who will listen, understand, and believe them about their symptoms because these patients are determined have the right to receive adequate care from their doctor. To illustrate, Lian and Robson studied patients with chronic fatigue (a form of MUS). In their study, their participants described their consultations with primary healthcare doctors as a “battle” to “preserve their right to self-determination,” in order to receive adequate healthcare rather than being ignore by doctors misusing their authority over the patient.

Overall, implementing personalized healthcare and educating future physicians about MUS and teaching effective consultation skills will improve the relationship between doctors and patients with MUS. It is extremely important for the doctor-patient relationship to be in good standing when dealing with cases of MUS because it requires both the doctors and patients to work together to effectively treat and manage their symptoms. The current problems faced in primary healthcare disrupt the doctor-patient relationship especially in MUS patients. Solving this problem will not only improve the doctor-patient relationship, but also improve the way doctors’ diagnosis and recognize rare or hidden illnesses.

Annotated Bibliography:

Guthrie, Else. “Medically Unexplained Symptoms in Primary Care”. Advances in   Psychiatric Treatment (2008), vol.14, pg. 432-440. Accessed on February 5, 2018. http://apt.rcpsych.org/content/aptrcpsych/14/6/432.full.pdf

This article recognizes the doctor-patient relationship in cases of MUS in primary care. Additionally, this article acknowledges the challenges for doctors and the patients’ frustration when doctors normalize their symptoms. This article was used for me to learn more from the doctors’ perspective of MUS, as well as common ways they manage these cases, specifically normalizing patients. This source is reliable because acknowledge view points from doctors and patients and cite other works used to support their study.

Lowth, Mary. “Medically Unexplained Symptoms.” Practice Nurse (2/20/2015), Vol. 45, Issue 2, pg. 36-40. EBSCOhost Consumer Health Complete. Accessed on February 10, 2018. http://web.b.ebscohost.com/chc/detail?vid=0&sid=f16549d1-783c-44ab-ae3d-f5add4dcfc6d%40sessionmgr103&bdata=JnNpdGU9Y2hjLWxpdmU%3d#AN=101192360&db=cmh

In this article, gives a thorough summary of the problems with MUS and gives guidelines for the medical community. It addresses effective and poor consultation skills and is intended for readers to learn more about MUS. In my report, I quote this article to help define MUS and to support my problems and solutions. I believe this source is very reliable because it is current research on MUS, covers various issue dealt with MUS patients, and is intended to educate the readers of MUS. Additionally, the author references other sources.

Natelson, Benjamin H. “Lost in a System Where Doctors Don’t Want to Listen.” Washington Post (2008), http://www.washingtonpost.com/wp-dyn/content/article/2008/08/01/AR2008080102953_2.html

This article provides an example of a patient who didn’t receive adequate care from multiple doctors and the author explains the problems in medical field that impact patients with medically unexplained illnesses. In my report, I quote a fact that describes the lack of evidence for patients with MUS, the limited amount of time doctors has, and include problems created by normal tests. I believe this source is reliable because the author is a doctor, specialized in medically unexplained illnesses. Additionally, he has studied symptoms related to MUS at Beth Israel Medical Center and wrote the book, “Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong.”

Lian, Olaug S. and Catherine Robson. “‘It’s incredible how much I’ve had to fight.’ Negotiating medical uncertainty in clinical encounters.” International Journal of Qualitative Studies on Health and Well-Being, 2017, Vol. 12, no. 1, June 2017. EBSCOhost, doi:10.1080/17482631.2017.1392219.

In this study, the authors surveyed and reviewed responses by patients with chronic fatigue, a form of MUS. As a result, they looked into the patients’ perspective of their doctors in primary healthcare. They discovered in order for patients to manage their symptoms it requires equal authority and participation between the doctor and patient. This article helped me support the problems patients with MUS face in primary care. This article is reliable because it explained in depth the problems patients’ experience and support it with their own evidence from their study.

Isaac, Margaret L. and Douglas S. Paauw. “Medically Unexplained Symptoms.” Medical Clinics, Vol. 98, Issue 3, May 2014, pp. 663-672. Google Scholar, http://www.medical.theclinics.com/article/S0025-7125(14)00028-5/pdf

In this article, the authors acknowledge what is MUS, symptoms, problems when diagnosing and testing, and recommend how doctors should treat their patients. They conclude that the medical community should consider prioritizing the doctor-patient relationship for cases of MUS. In my report, I use this article to help support my solutions by proving the need for patient-centered care to improve doctor-patient relationships. This article is reliable because they acknowledge their references and support their claims with cases of patients with MUS.

Edward, Todd M. et al. “The Treatment of Patients with Medically Unexplained Symptoms in Primary Care: A Review of the Literature.” Mental Health in Family Medicine, 7.4.2010: 209-221. Print. Google Scholar, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083260/

In this article, it views both the patients concerns for cases of MUS and challenges doctors face because of the lack of knowledge and education of MUS. By analyzing past literatures on MUS in primary care, they could determine the problems in primary care. I use this article to acknowledge the problems in primary care for patient with MUS the damage the doctor-patient relationship, such as economic factors. Additionally, this article encourages patient-center care for MUS patients, which support my solution for implementing personalize healthcare. I assume this research is reliable because multiple medical professors with either PhDs or MD involved in family medicine study past literature to learn from past difficulties in primary care.

Chawla, Nitesh V., and Darcy A. Davis. “Bringing Big Data to Personalized Healthcare: A Patient-Centered Framework.” Journal of General Internal Medicine 28. Suppl 3 (2013): 660-665. PMC. Web. 10 February 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744281/

In this article, it explains that personalize healthcare is intended for patient-centered methods using a computer program called CARE to give doctors more resources when diagnosing and preventing common and rare illnesses. This source is used to explain my solution for MUS patients by using personalize healthcare to help manage and treat their symptoms. I assume this article is reliable because both authors have PhDs in computer science and engineering.

Wileman, Lindsey, Carl May, and Carolyn A. Chem-Graham. “Medically Unexplained Symptoms and the Problem of Power in the Primary Care Consultation: A Qualitative Study.” Family Practice, Vol. 19, Issue 2, 1 April 2002, pp. 178-182. https://doi.org/10.1093/fampra/19.2.178

In this article, the authors research problems in primary care with general physicians by interviewing a group of GPs. It acknowledged the doctors’ frustration of MUS and sense of feeling unable to help their patients. In my report, I acknowledge how their study support my solution to add further education in the medical schools to help improve the relationship between the doctor and patients with MUS.