1. Medically unexplained symptoms: how can doctors help, not hinder? Christopher Dowrick Professor of Primary Medical Care University of Liverpool

2. Frank

• stomach pain

• • Oh no, its starting again

• headache

• mole on arm

• throbbing leg

3. Kroenke et al Am J Med 1989

4. Persistence in primary care

• 19% MUS >3 months

• • • • • Peveler et al, J Psychosom Res 1997

• 21% somatoform disorders persistent

• • • • • Jackson & Kroenke, Psychosom Med 2008

5.

• Do doctors help, or hinder?

6. Mismatch of help seeking and care

• Liverpool Primary Care Study

• • Psychosocial agendas voiced

• • • 61% patients referred to emotional or social problems

• • • 70% requested explanations for symptoms

• • But often unheard

• • • In 67% consultations, GPs indicated physical disease could be present

• • • In only 16% did GPs make empathic statements

• • • • Ring et al, Soc Sci Med 2005

7. GPs more likely to propose symptomatic management Z=12.19, P