27 August 2012

episode

Health Report 28 min 2 speakers 8 chapters transcribed 3 days ago

▲ 0

Transcript

jump: chapters · speakers · find in transcript

Transcript

Transcript generated automatically by AI and may contain errors.

What is the main focus of this episode and why are medically unexplained symptoms important?

Norman Swann 0:00

Hello and welcome to the Health Report with me, Norman Swann. Today, what to look for in a doctor and what it takes to be a good doctor, and is it good enough to be going to see a good enough doctor? Plus, an incredibly common phenomenon going to see the doctor with a problem, having lots of tests, seeing lots of specialists, only to be told they can't find anything wrong. It's called having medically unexplained symptoms, and it's thought apart from the disability they can cause, the added Financial costs to the healthcare system and economy can be up to eighteen thousand dollars a person. Someone who's had a long research interest in unexplained symptoms is Michael Sharp. He's professor of psychological medicine at the University of

Michael Sharp 0:38

Oxford. People commonly go and see a doctor because they feel something wrong, like they have a symptom. And the assumption that people often make is you go and see a doctor and he examines you, he does the test and he says, Ah, I've found what the cause of your symptom is. There's something wrong here. What is less often known that in very commonly people go to the doctor with a symptom and the doctor says, Actually, I can't find a cause for this symptom. It's a troublesome symptom, it doesn't go away, but I can't find a cause, and because I can't find a cause, I can't give you anything to get rid of it. This problem is sometimes called, perhaps not very helpfully, medically unexplained symptoms because it's unexplained by the traditional model of medicine, which is finding a disease in the body.

Michael Sharp 1:18

Can you give me an example? I mean is this chronic pain we're talking about? Chronic headaches or what? Almost any symptom can be unexplained, but the most common ones are headache, abdominal pain, chest pain, fatigue, dizziness. And they often turn up at neurologists? They can turn up in primary care but can then be referred to one of a whole range of specialties, from general surgery with abdominal pain, cardiology for chest pain, but neurology has a particularly wide range of symptoms that present dizziness, fainting attacks, weakness, pain, fatigue. They can all be due to diseases of the nervous system. And neurologists are pretty good at identifying whether there's anything wrong with the nervous system or not.

Michael Sharp 2:02

So we know that about a quarter of the patients sent to neurologists have symptoms where the neurologist says, I can't find a disease that's explaining this. Does that mean they don't have disease? Well, it doesn't mean they don't have the symptoms and of course it's all too easy to then dismiss the patient because you can't find anything wrong. It's all in your head. It's all in your head. Which of course is what people with unexplained symptoms fear being told because they know it's real. That is indeed a major part of the problem with both some doctors and in the message that they give to patients. The mistake that if you can't find anything in the body you must somehow have imagined it or made it up.

Michael Sharp 2:41

And of course that's a very unhelpful thing to be told. So how have you studied this? It's a big problem in terms of the number of people coming forward to specialist care. The first thing is it's a big problem. It's a big problem in primary care. And primary care chooses who they send to secondary care and it is across medical specialties about a quarter to a third of the patients seen fall into this category. So it's a big problem. The second question is, do these people all go on to have disease that to have the symptoms explained if you just wait? And again the evidences and our studies in neurology suggest even after a year, very, very few people, once they've been assessed by a neurologist, turn out to have a disease.

Michael Sharp 3:23

So it isn't that if you wait the disease will always become clear. It usually doesn't.

What are medically unexplained symptoms and how frequently do they occur in primary and specialist care?

Norman Swann 3:28

And if you go and see a better neurologist?

Michael Sharp 3:30

And if you go and see a better neurologist, people of course do end up doing this. They go and see multiple doctors in the hope that s one of them will find a symptom. But once you've seen a competent specialist doctor, the chance of a second one finding something becomes vanishingly small.