Medically Unexplained Symptoms in Primary Care

Fourteen common physical symptoms are responsible for almost half of all primary care visits.Only about 10% to 15% of these symptoms are found to be caused by an organic illness over a 1-yearperiod. Patients with medically unexplained symptoms are frequently frustrating to primary care physiciansand utilize medical visits and costs disproportionately. This paper will review the relationshipbetween psychological distress and the decision to seek medical care for common physical symptomssuch as fatigue and headache. Evidence will be presented demonstrating that an increasing number ofmedically unexplained symptoms over a patient’s lifetime correlate linearly with the number of anxietyand depressive disorders experienced, the score on the personality dimension of neuroticism, andthe degree of functional impairment. Several scales measuring somatization and hypochondriasis arerecommended for primary care and medical specialty patients.