Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008;26(2):99-105.
doi: 10.1080/02813430802048662.

The diagnostic challenges presented by patients with medically unexplained symptoms in general practice

José M Aiarzaguena  1 , Gonzalo Grandes, Agustín Salazar, Idoia Gaminde, Alvaro Sánchez
Affiliations

The diagnostic challenges presented by patients with medically unexplained symptoms in general practice

José M Aiarzaguena et al. Scand J Prim Health Care. 2008.

Abstract

Objective: To describe the complexity of somatizing patients' symptomatology and the difficulties involved in the diagnostic process. DESIGN. Cross-sectional study of patients with medically unexplained symptoms.

Setting: Basque Health Service primary care centres in Bizkaia, Spain.

Subjects: The study comprised 156 patients selected at random from a list of 468 patients who had presented, over the course of their lives, six or more medically unexplained somatic symptoms for females and four or more for males, identified retrospectively by their practitioners.

Main outcome measures: Physicians interviewed these patients using the somatoform symptoms section of the Composite International Diagnostic Interview (CIDI), and the Primary Care Evaluation of Mental Disorders (PRIME-MD). The Medical Outcomes Survey Short Form 36 (SF-36) was filled in at home. Organic diseases whose diagnosis was established during the previous year were included in the study by consulting patients' medical records.

Results: Patients were found to have a median of three medically explained and 12 medically unexplained symptoms. Mental disorders were found in 83% of cases, associated with other morbidity categories in 78%. The predictive value of symptoms was lower than 26% for diagnosing broad disease categories.

Conclusions: These results depict an extremely difficult scenario for dichotomous diagnostic strategies aimed at classifying patients' symptoms as either organic or functional. Rather than struggling to choose one of these hypotheses, it is suggested that both of them should always be addressed concurrently.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Health-related quality of life in somatizing patients compared with a population-based community sample, patients with diabetes mellitus, and patients with chronic obstructive pulmonary disease (COPD). Abbreviations: pf = physical functioning; rp = role–physical; bp = bodily pain; gh = general health; vt = vitality; sf = social functioning; re = role – emotional; and mh = mental health.
See this image and copyright information in PMC

References

    1. Barsky AJ, Borus JF. Somatization and medicalization in the era of managed care. JAMA. 1995;274:1931–4. - PubMed
    1. Margo KL, Margo GM. The problem of somatization in family practice. Am Fam Physician. 1994;49:1873–9. - PubMed
    1. Jeffrey L, Susman MD. Mental health problems within primary care: Shooting first and then asking questions? J Fam Pract. 1995;41:540–1. - PubMed
    1. Woivalin T, Krantz G, Mantyranta T, Ringsberg KC. Medically unexplained symptoms: Perceptions of physicians in primary health care. Fam Pract. 2004;21:199–203. - PubMed
    1. Reid S, Whooley D, Crayford T, Hotopf M. Medically unexplained symptoms. GPs’ attitudes towards their cause and management. Fam Pract. 2001;18:519–23. - PubMed

Publication types