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SYMPTOM DIAGNOSES: OFTEN THE BEST DESCRIPTION OF PATIENTS’ PROBLEMS. INGE OKKES JEAN KARL SOLER HENK LAMBERTS. WHY MUS IS NOT A HELPFUL CONCEPT. REASON FOR ENCOUNTER. DIAGNOSIS. RFE. SYMPTOM DIAGNOSIS. SYMPTOM/ COMPLAINT. sometimes repeatedly, and for quite some time.
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SYMPTOM DIAGNOSES: OFTEN THE BEST DESCRIPTION OF PATIENTS’ PROBLEMS INGE OKKES JEAN KARL SOLER HENK LAMBERTS
DIAGNOSIS RFE
SYMPTOM DIAGNOSIS SYMPTOM/ COMPLAINT sometimes repeatedly, and for quite some time
MEDICALLY UNEXPLAINED SYMPTOMSConcept: a substantial proportion of patients present (over an extended period of time) with physical complaints not attributable to a defined disease. Hypothesis: these patients have a psychosocial/ psychiatric problem that expresses itself through the presentation of physical symptoms
MUS SHORTNESS OF BREATH CHEST PAIN TIREDNESS HEADACHE ABDOMINAL PAIN NUMBNESS LOSS OF APPETITE LUMP IN THROAT EXTREMITY PAIN NAUSEA CONSTIPATION WEIGHT CHANGE LOOSE BOWELS PALPITATIONS BACKPAIN FLATULENCE/GAS/BELCHING SLEEP DISTURBANCES RESTLESSNESS DIZZINESS JOINT PAIN
play a major role high prevalence a large number common on average 13% 10-20% 20-50% appr. 20% 20-50% appr. one-quarter to one-half at least one third one third 25-75% PREVALENCE OF MUSaccording to the MUS literature
WHAT IS THE ALTERNATIVE? THE SYMPTOM DIAGNOSIS
‘I find it personally objectionable to ask the patient why he has come to see me, and then diagnose his problem in the form of a symptom diagnosis. I have not spent most of my adult life in medicine to be diminished in this way. I can diagnose any symptom or complaint of my patients with a proper disease label’.
A symptom diagnosis is not a diagnosis-without-a-meaning, on the contrary…. …what is truly meaningless is…
the idea that, e.g., heart burn as a symptom diagnosis is better defined when called ‘medically unexplained’ heart burn • that things get better when this diagnosis is, subsequently, lumped into a category that includes all types of very heterogeneous other symptom diagnoses
ADVANTAGES OF USING THE • SYMPTOM DIAGNOSIS: • For direct patient care: it is based on the patient’s RFE, and documenting it as such prevents patients from being labelled with an uncertain diagnosis that might lead to unnecessary concern and inappropriate interventions. • 2.For epidemiology: it prevents the FD from ‘forcing’ a disease diagnosis into a box, even if it does not fit, thus keeping the disease rubrics ‘clean’.
SOMETHING ELSE IS WRONG WITH MUS • The term implies that all symptoms are, or should be medically explainable, which is definitely untrue, and really quite an arrogant and very doctor-centered point of view • In fact: most symptoms are medically unexplained
FOR EXAMPLE: • The case of thirst/diabetes • The case of headache/sinusitis • The case of weight change/depression • The case of heartburn/gastric ulcer
Patients feel what they feel, in and out of the medical model….. ….it is not their fault that their symptoms do not fit the medical model