Objectives: To explore junior doctors’ knowledge about and experiences of managing patients with medically unexplained symptoms (MUS) and to seek their recommendations for improved future training on this important topic about which they currently receive little education.
Design: Qualitative study using in-depth interviews analysed using the framework method.
Setting: Participants were recruited from three North Thames London hospitals within the UK.
Participants: Twenty-two junior doctors undertaking the UK foundation two-year training programme (FY1/FY2).
Results: The junior doctors interviewed identified a significant gap in their training on the topic of MUS, particularly in relation to their awareness of the topic, the appropriate level of investigations, possible psychological comorbidities, the formulation of suitable explanations for patients’ symptoms and longer term management strategies. Many junior doctors expressed feelings of anxiety, frustration and a self-perceived lack of competency in this area, and spoke of over-investigating patients or avoiding patient contact altogether due to the challenging nature of MUS and a difficulty in managing the accompanying uncertainty.
They also identified the negative attitudes of some senior clinicians and potential role models towards patients with MUS as a factor contributing to their own attitudes and management choices. Most reported a need for more training during the foundation years, and recommended interactive case-based group discussions with a focus on providing meaningful explanations to patients for their symptoms.
Conclusions: There is an urgent need to improve postgraduate training about the topics of MUS and avoiding over-investigation, as current training does not equip junior doctors with the necessary knowledge and skills to effectively and confidently manage patients in these areas. Training needs to focus on practical skill development to increase clinical knowledge in areas such as delivering suitable explanations, and to incorporate individual management strategies to help junior doctors tolerate the uncertainty associated with MUS.
Strengths and limitations of this study: This is the first known study to explore newly-qualified doctors’ experiences of managing patients with medically unexplained symptoms (MUS) and to identify postgraduate training needs in this area.
Our study highlights an important gap in junior doctors’ knowledge about MUS and emphasises the importance of educating doctors at an early and clinically-relevant stage of their career.
Junior doctors were forthcoming when discussing negative viewpoints towards patients with unexplained symptoms and the challenges and difficulties they have faced.
We obtained a range of views by ensuring maximum diversity according to gender, age, ethnicity and training level.
Participants were recruited from the North Thames London region, and the views expressed may not be representative of other newly-qualified doctors within the UK or elsewhere.
Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study, by Katherine Yon, Sarah Nettleton, Kate Walters, Kethakie Lamahewa, Marta Buszewicz in BMJ Open 2015; 5:e009593