MUS MX

ommonly suggested strategies for managing medically unexplained illness are as follows [1,2]:

1. Help the patient make sense of their symptoms.
2. Acknowledge the symptoms are real and distressing.
3. Be up-front with the patient in advising them that their symptoms may be unexplainable.
4. Focus on the impact of symptoms rather than searching for a diagnosis.
5. Discuss the likelihood of pathology results being normal to prevent disappointment.
6. Share your uncertainty with the patient, as well as sharing decisions about further investigation and management.
7. Use explanatory models or metaphors to address patient fears.
8. Always consider the role of past or current trauma, psychosocial stress and personal vulnerabilities.
9. Co-ordinate care to avoid duplicating investigations and exacerbating of iatrogenic harm.
10. Offer symptom relief and practical support to address disability (for example, home help or workplace assessment).

I feel I would have difficulty with point 6 as that may imply ‘the blind leading the blind’, some erosion of clinical trust at the expense of possible gain of empathy, and there can only be one captain on the ship! Should patients dictate investigations and therapy when maybe none are indicated?