Managing medically unexplained illness in general practice

Background Patients with medically unexplained symptoms commonly present to general practice and experience significant disability. Many have a history of trauma, which complicates the therapeutic relationship between doctor and patient. Because diagnosis is an expected outcome of a medical interaction, doctors and patients can feel frustrated and lost without one. Objectives This article provides practical management strategies that general practitioners (GPs) can use when patients present with medically unexplained symptoms. Discussion Three types of common presentations are discussed. Enigmatic illnesses occur when the doctor and patient believe that a biomedical disease is likely, but a diagnosis is not forthcoming. Contested illnesses occur when a patient is committed to a diagnosis the doctor does not accept. Chaotic illnesses occur when symptoms are over-determined; there are many possible diagnoses, but none fully explain the complex web of distress the patient experiences. Common strategies for managing medically unexplained symptoms are discussed, and specific approaches to each presentation are outlined.