Understanding the unexplained : healthcare professionals' attitudes towards, and understanding of, medically unexplained symptoms

Systematic Literature Review: The literature review explored why healthcare professionals have negative attitudes towards patients with Medically Unexplained Symptoms (MUS) and how these attitudes developed. Six databases were searched and twelve papers were found. A meta-ethnography approach was used to synthesise the papers and draw overarching understandings. All of the papers researched medical doctors in Europe. The synthesis revealed that a lack of training contributed to negative attitudes. The attribution of symptoms impacted attitudes. The doctor-patient relationship was found to be a key mediating factor for attitudes. Professionals also had to manage their own emotional reactions to MUS presentations. The review suggests that negative attitudes may reflect the difficulty for professionals in working with the MUS presentation. Further education and support is required. Empirical Research Project: Research suggests that culture can impact the presentation of symptoms and engagement with psychological services. However, how culture impacts this specifically within the context of Medically Unexplained Symptoms (MUS) is not known. Twenty psychologists took part in semi-structured interviews to explore this. The transcripts were analysed using Thematic Analysis. Cultural identity and sense-making was an overarching theme which noted the impact of cultural narratives, faith and spirituality, and intersectionality on the explanations of MUS. Systemic barriers to access were found to be related to family narratives, stigma and institutional discrimination. The link between mental health and MUS was emphasised, with the link between mind and body and the cycle of poor mental health being contributing factors. Earlier psychological intervention and co-construction of meaning were noted as key in improving the patient journey. It was clear that culture needed to be considered within MUS to improve patient outcomes.