ABC of Medically Unexplained Symptoms by Christopher Burton

By Christopher Burton

This fresh identify addresses the advanced matters confronted through basic overall healthiness care practitioners in treating and coping with sufferers with ‘medically unexplained symptoms'. It goals to strengthen guidance and rules to aid determine sufferers with medically unexplained signs, as they're regularly underdiagnosed, and to regulate signs extra successfully with energetic sufferer involvement.

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1. Further reading Gask L, Dowrick C, Salmon P, Peters S, Morriss R. Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. J Psychosom Res 2011;71:325–34. Burton C, Weller D, Worth A, Marsden W, Sharpe M. A primary care symptoms clinic for patients with medically unexplained symptoms: pilot randomised trial. BMJOpen 2012;2:e000513. Woolfolk RL, Allen LA. Treating Somatization: A Cognitive Behavioral Approach.

The Rome III criteria for dyspepsia state that symptoms must have been present for at least the past 3 months and must have started 6 month prior to diagnosis. A prerequisite for the diagnosis of functional dyspepsia, and all function gastrointestinal syndromes is that there is no evidence of an underlying structural disease that is likely to explain the symptoms. Scenario 1 ‘Brian’ is a 36-year-old bank employee suffering from intermittent stomach complaints, mainly a burning sensation in his upper abdomen, sometimes with nausea.

2 Score for risk of heart disease in primary care patients with chest pain. Characteristic of chest pain Points Epidemiology Male aged ≥55 or female ≥65 Any prior clinical vascular disease (coronary, peripheral or cerebrovascular) 1 1 History Worse during exercise Patient ‘concerned that the pain is cardiac’ or ‘feeling very concerned about the pain’ 1 1 Examination Pain not reproduced by palpation 1 Total score: ≥3 probability of coronary heart disease (CHD) at least 33%; ≤2 probability of CHD <3%.

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