The Priory Group is launching a new service for patients to provide early assessment of medically unexplained symptoms (MUS).

The Early Detection of Medically Unexplained Symptoms service is available across 20 of Priory’s hospitals and Wellbeing Centres, and will allow expert therapists to work with patients who have been living with chronic conditions that have no clear medical explanation.

MUS accounts for up to a fifth of all GP consultations in the UK, and with psychological assessment playing a pivotal role in assessing and treating MUS, Priory’s new service will work on a pioneering approach based on the belief that treating an associated psychological problem can often relieve physical symptoms.

What is MUS?

MUS are formally described as “persistent physical complaints that do not have a readily recognisable medical cause. The pain, worry and other symptoms are nonetheless real and cause distress”.

When physical symptoms last for more than three to four weeks with no recognisable problem or condition, the patient is then considered as having MUS, although such symptoms can be also relate to little understood syndromes such as:

• Chronic fatigue syndrome (CFS) – also known as ME
• Irritable bowel syndrome (IBS)
• Fibromyalgia (pain all over the body)

MUS or ‘functional symptoms’, are increasingly becoming recognised as a common cause of discomfort and concern for patients, costing the NHS in England an estimated £3 billion a year in repeat GP and hospital visits, placing it above even stroke or heart disease in terms of overall treatment costs.   

MUS are most prevalent in women, younger people, people who have had a recent infection, and people who have previously been diagnosed with anxiety and depression.

Some common complaints associated with MUS include the following:

• Backache
• Fatigue
• Indigestion
• Tension headaches
• Heart palpitations

Innovative solution for MUS patients

It is hoped that this new approach to combating MUS will offer additional encouragement for patients to seek out potential relief for their undiagnosed discomfort by engaging in the service’s offering of appropriate treatment plans to help ease both the emotional and physical symptoms. 

Many people with MUS can also have anxiety or depression; although much of this new initiative is about acknowledging that the physical discomfort is not simply ‘all in the mind’. Moreover, it acknowledges that MUS can affect a patient’s ability to function in daily life, with this method hoping to achieve a greater likelihood of successful reduction of such symptoms through a combination of both mental and physical treatments.

In response to this growing understanding of medically unexplained symptoms and their potential impact on a patient’s quality of life, a bespoke screening programme has been developed by Dr Hayley van Zwanenberg, Priory Group’s Associate Medical Director.

She says; “It is well known that people of all ages have medically unexplained symptoms and that these people will visit GPs 50% more than the general population and will usually be seen in hospital outpatient clinics about 33% more, incurring huge costs to the NHS.

“And, in addition, this issue also leads to days off sick, with significant financial impact on companies, individuals and the economy as a whole.

“Unexplained symptoms will also lead to immeasurable worry for patients, with research showing that at least 30% will have a missed psychiatric illness, such as stress, health anxiety, panic attacks. Currently, there is very little available to address this immense issue, so I am very proud that we are now able to offer such an innovative yet simple solution in well governed settings with appropriately trained clinicians.”

Therapist intervention can greatly reduce discomfort

Although many people with medically unexplained symptoms are reluctant to have a mental health assessment, studies show that when patients accept intervention from psychiatrists or psychological therapists, the severity of symptoms can be reduced by up to 60%.

Dr van Zwanenberg believes these assessments should be considered for all patients with three or more months of symptoms without cause, currently accounting for 20% of GP consultations. A programme to screen patients for mental health symptoms and disorders will help identify those who need psychological support, pointing them in the right direction for appropriate, confidential support – improving their quality of life and avoiding further unnecessary investigations.

Dr van Zwanenberg adds; “If screening for mental health issues could lose its stigma and become standard practice for persistent unexplained symptoms with no clear physical cause, the benefits to patients, employers and the NHS could be huge.

“As medical professionals, we are taught to reassure patients. So, if no pathology has been found, it is natural for a GP or specialist to want to reassure the patient that nothing is wrong. However, I believe this is unhelpful because if we say, ‘there’s nothing wrong’, all we’re doing is leaving the patient with ongoing symptoms and no understanding of what causes them to feel as they do.”

Seeking help and support when experiencing MUS

Priory facilities take referrals from individuals, GPs and schools, and accept self-funding patients and those with health insurance, with many not realising their health insurance may cover a mental health assessment and treatment.

GP, Dr Mo Rashid, said in support of this approach; “The launch of this new service sounds very promising. Medically unexplained symptoms can lead to a huge amount of time spent on tests when perhaps early psychological intervention could be far more beneficial in helping patients come to terms with, and have a named condition, for their symptoms.”