Pathways to Care for Medically Unexplained Symptoms at a Specialty Psychosomatic Clinic in South India in 2014

Abstract

Background: A growing body of evidence suggests that patients with medically unexplained symptoms (MUS) tend to delay help seeking behaviours. Objectives: The aim of this study was to explore the pathway to care for patients with MUS at a specialty psychosomatic clinic. Materials and Methods: The clinic caters to patients with MUS referred from other departments or directly seeking treatment. After detailed assessment, diagnosis was made as per ICD 10 clinical descriptions, diagnostic guidelines, and management plan. The pathway of care for patients registered in this clinic was assessed, using a structured questionnaire. Results: Pathway-of-care information was available for 49 out of the 53 patients (92.5% of the sample) registered in the first 8 months of the clinic. The median age of the participants was 36 years, of them, 25 (51.0%) were female, 40 (81.6%) married, and 32 (65.3%) belonged to nuclear family. Thirty-three patients (67.3%) visited general practitioners, 13 (26.5%) had visited traditional practitioners and faith healers, 48 (98.0%) had made visits to specialists/ tertiary care centers, and nine (18.4%) had consulted psychiatrists before being referred to our center. The first point of contact was the general practitioner in the majority of the cases (55.1%). Patients had waited for a mean of 21.73 (± 36.55) months and taken 5.53 (± 3.86) consultations before referring to our clinic. Conclusions: Patients with medically unexplained somatic symptoms may undertake considerable number of consultations before being referred to psychiatric treatment services. This signifies the need to train more doctors, particularly general practitioners, to empower them to recognize and manage unexplained medical symptoms.