Medically unexplained symptoms.

The review by Dr Page and Professor Wessely (May 2003 JRSM1) is timely and excellent. As they point out, medically unexplained symptoms (MUS) are probably the most common reason for attendance at general medical out-patient clinics. Yet students are not exposed adequately to this condition during either undergraduate or postgraduate training. Current medical training is so oriented as to make students always look for abnormal findings on examination. Therefore, when a doctor encounters a patient with MUS, the absence of physical abnormalities generates frustration. This is compounded by lack of effective pharmacological or surgical therapy. Very little research has been done on MUS considering the amount of suffering and financial loses they cause. Despite the temptation to refer to multiple specialists, the best option for primary physicians is to keep patients with MUS under their own care. The lack of enthusiasm and the feeling of frustration engendered by these patients can lead to poor assessment and underinvestigation as well as multiple unnecessary investigations. Somehow a middle path has to be found. The drugs used for treatment of MUS commonly have adverse events and the mainstays of treatment are counselling, reassurance and periodic follow-up. These matters deserve detailed coverage in the medical curriculum.