Management of medically unexplained symptoms in primary health care.

OBJECTIVE: Recent studies have found that somatic symptoms with unidentified organic basis are common in primary care settings but physicians find often difficult to manage them. The aim of this study is to evaluate the characteristics of patients with medically unexplained physical symptoms (MUS) in primary health care and the way to manage them. METHOD: A 120-items questionnaire was administered to a representative sample of primary care physicians (n = 174). The questionnaire covered the following areas: the frequency with which unexplained symptoms are reported by patients; the socio-demographic characteristics associated with them; the interventions provided to by physicians. Finally we asked physicians to evaluate their psychosomatic appraisal. RESULTS: The study showed that most of the primary care physicians encounter patients with MUS (74% answered often). The most frequent symptom encountered is sleep problems (75% answered often). The next most common symptoms are digestive difficulties and headache (71% answered often), following by palpitations (70% answered often), fatigue ( 67% answered often) and abdominal pain or swelling (65% answered often). The main socio-demographic characteristics related to patients with MUS include female gender, middle-age (40-50 years old), separated without children, having high educational qualification, housewives, unemployed or subordinate worker. Providing reassurance and support (67%), prescribing drugs (60%) and listening (59%) are the most frequent interventions provided by general practitioners, while referring to a specialist is the less frequent (26%). Finally, most of the primary health physicians (95%) consider insufficient their psychosomatics background. CONCLUSION: The study shows that patients with MUS are very frequent in primary care. However primary care physicians need a greater grounding in this area of health care.