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Q J Med 2000; 93: 21-28
© 2000 Association of Physicians

Medically unexplained symptoms: how often and why are they missed?

C. Nimnuan, M. Hotopf and S. Wessely

From the Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London, UK

Received 22 April 1999 and in revised form 29 October 1999

Professor S. Wessely, Professor of Epidemiological and Liaison Psychiatry, Academic Department of Psychological Medicine, Guy's King's & St Thomas' School of Medicine and Institute of Psychiatry, 103 Denmark Hill, London SE5 8AF. e-mail: sphascw{at}iop.kcl.ac.uk

We assessed risk factors affecting the provisional diagnosis of medically unexplained symptoms made by physicians in new patients, in 526 clinical encounters. Comparisons were made between the doctor's initial assessments regarding the nature of symptoms, and the final diagnosis. Physicians were more likely to err on the side of diagnosing the symptoms as medically explained rather than unexplained. When physicians perceived the interaction with the patient to be positive, they were more likely to make a provisional diagnosis that the symptoms were explained. Conversely, a negative perception of the interaction was associated with an increased likelihood of viewing symptoms as medically unexplained. Physicians should be aware of the effect of their own perceptions on their diagnostic behaviour.


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