How a GP can manage medically unexplained symptoms (MUPS)
This article describes some common approaches for a GP (or other primary care health professionals) to manage medically unexplained physical symptoms (MUPS).
Validation
- Acknowledge that the symptoms are real and distressing
- Explain that although the symptoms are real, a full assessment – history, examination, investigations (see below) and specialist referral if necessary – has been made and no medical cause found
- Acknowledge that medicine has limits and the uncertainty is frustrating.
Explanation
- Consider (and record) physical, psychiatric and psychosocial diagnoses and symptoms
- Provide an explanation for symptoms, and craft explanations that include the body and the mind
- Always consider the role of past or current trauma, psychosocial stress and personal vulnerabilities.
Symptom management
- Offer symptom relief and practical support to address disability (e.g. home help, workplace assessment)
- Encourage physical therapies (e.g. massage, physiotherapy, hydrotherapy)
- Manage comorbidities as effectively as possible
- Broaden the agenda beyond physical symptom management
- Address healthy lifestyle goals – individual and team sport and activities (music etc).
Psychological care
- Encourage this to address the impact of illness and underlying issues that may exacerbate symptoms
- Consider referral to IAPT (NHS counsellor) or liaison psychiatry
- Consider anti-depressants etc.
Coordination of care and harm reduction
- Coordinate care to avoid duplication of investigations that may lead to iatrogenic harm
- Repeat examination if required, even if not normally indicated.
Other principles
- Check for new diagnoses when the illness changes significantly (e.g. the emergence of a new symptom) or during a yearly health check
- Adopt a ‘caring’ not ‘curing’ approach. Use empathy
- Manage the therapeutic relationship carefully and seek support if it becomes unhelpful. And try to avoid a dependent relationship. For example, limit the number of patent contacts with an individual doctor.
Summary
We have described how a GP can manage medically unexplained symptoms (MUPS). We hope it has helped you.
