Towards an ethically informed framework for managing patients with medically unexplained symptoms: developing boundary principles

Fernando, Buddhika Lalanie

Abstract

Introduction
Patients with medically unexplained symptoms (MUS), i.e., physical complaints not fully explained by somatic/psychiatric pathology, are well-documented as a significant problem in primary care. Yet, the issues these patients and their doctors face have rarely been examined from an ethical perspective.

Aim
Use the views and experiences of patients, and, empirical data from routinely recorded primary care consultations, to derive boundary principles – a series of normative statements that describe how ethical concerns around MUS should be characterized and responded to.

Methods
To ascertain facts and values that operate on the problem 1) a qualitative evidence synthesis of views and experiences of patients/doctors in diagnosing and managing patients with MUS, 2) identification of patients using routinely recorded electronic health records in primary care, and, analysis of epidemiological data as well as patterns of resource usage, and 3) systematic review of costs of patients with MUS in England and a cost of illness study, were carried out.

Results
Patients and doctors shared concerns about managing diagnostic uncertainty, emotional experiences (e.g., stigma, stereotyping), and resource availability. EHR data indicated support for these concerns: for e.g.: 55% of patients without a diagnosis continued to consult for unexplained symptoms for five years consecutively; average annual consultation rate for patients who did not have their illness named was 22 cf. 12 for patients with a diagnosis; around a fifth of diagnosed patients had no investigations or referrals during five years of consulting, and around two-thirds of patients had a mental health issue on record. Estimated total cost of MUS to the NHS in 2021 was £4.6bn and the annual cost of each new patient cohort was £452m. Boundary principles derived from these values and facts were centered around building a therapeutic alliance based on a culture of respect, harm minimization and improved resources and capabilities.

Citation

Fernando, B. L. (2024). Towards an ethically informed framework for managing patients with medically unexplained symptoms: developing boundary principles. (Thesis). Keele University. Retrieved from https://keele-repository.worktribe.com/output/855660

• Thesis Type: Thesis
• Deposit Date: Jun 21, 2024
• Publicly Available Date: Jun 21, 2024
• Public URL: https://keele-repository.worktribe.com/output/855660
• Award Date: 2024-06