Have you ever had a headache that you knew was related to stress or back pain that flared up every time you had a negative encounter with a co-worker? Then you know what a medically unexplained symptom is. No, these symptoms are not “in your head”, they are real and are part of a large majority of medical visits, especially to primary care. Integrated care provides a means for patients to receive timely, targeted treatment for medically unexplained symptoms, reducing frustrating and ineffective encounters with medical providers by integrating professionals trained to work with these issues and by also sensitizing medical teams to the reality that not all symptoms fall neatly into standard disease/ condition categories. Read more below!
Interested in learning even more?
MUS stands for Medically Unexplained Symptoms which are physical symptoms not explained by diagnostic evaluation for organ disease or structural abnormalities. People with MUS account for 25 – 33% of primary care patients. They create frustration out of proportion to their numbers because few healthcare clinicians have had formal training about the psycho-physiologic causes of this form of patient presentation.
For MUS, outcomes similar to those achieved for patients with organ disease and structural abnormalities can be accomplished when medical and behavioral clinicians collaborate. The primary tasks for medical clinicians are to rule out organ/structural etiologies and persuade patients that psychosocial stress can be a contributing factor to pain and other physical symptoms. The primary tasks for behavioral clinicians are to assess for psychosocial stress, for the long-term impact of childhood adversity, and for undiagnosed mental illness and then treat the problems that are found and, when necessary, refer for specialized mental health treatment. There are many known approaches to managing these symptoms which can be practiced and taught within medical settings like primary care. Treating MUS in this fashion also reduces the stigma associated with working through physical symptoms related to stress.
- David D. Clarke, MD; Senior Clinician Co-Chair, MUS SIG
Additional resources include:
- Clarke, David D. Diagnosis and treatment of medically unexplained symptoms and chronic functional syndromes. Families, Systems, & Health, Vol 34(4), Dec 2016, 309-316. LINK HERE
- The World Organization of Family Doctors is developing new guidelines for MUS and a link to the draft will be posted here later in 2017 or 2018.
- http://www.acestoohigh.com has a great deal of information about research into the connection between Adverse Childhood Experiences (ACEs) and health outcomes.
- http://www.curablehealth.com is an application for computers or smartphones incorporating a range of techniques for treating psychosocial causes of physical symptoms.
The goal of the SIG is to provide clinicians with the knowledge, tools and skills needed to confidently diagnose and treat MUS. To accomplish this we:
- Provide presentations at CFHA conferences
- Have presented a CFHA webinar
- Are developing a MUS toolkit, a collection of evidence-based resources that support understanding, assessment, and treatment of patients with medically unexplained symptoms. Professionals in primary care, behavioral health, psychotherapy, social work, pastoral care and related fields will benefit. The MUS Toolkit is designed to meet the need for factual knowledge and techniques of a broad range of healthcare professionals that has resulted from a lack of formal training in the past.
- Actively support introduction of diagnostic/therapeutic MUS programs into primary care by interested CFHA members and others.