The diagnostic challenges presented by patients with medically unexplained symptoms in general practice

Objective. To describe the complexity of somatizing patients’ symptomatology and the difficulties involved in the diagnostic process. Design. Cross-sectional study of patients with medically unexplained symptoms. Setting. Basque Health Service primary care centres in Bizkaia, Spain. Subjects. The study comprised 156 patients selected at random from a list of 468 patients who had presented, over the course of their lives, six or more medically unexplained somatic symptoms for females and four or more for males, identified retrospectively by their practitioners. Main outcome measures. Physicians interviewed these patients using the somatoform symptoms section of the Composite International Diagnostic Interview (CIDI), and the Primary Care Evaluation of Mental Disorders (PRIME-MD). The Medical Outcomes Survey Short Form 36 (SF-36) was filled in at home. Organic diseases whose diagnosis was established during the previous year were included in the study by consulting patients’ medical records. Results. Patien...