Programme no. 232-OP
Public Health
Ph.d. thesis: Symptom load and medically unexplained symptoms in the population and in general practice
Hedda Tschudi-Madsen*1
1Department of general practice,Institute of Health and Society, University of Oslo,0280 Oslo,Norway
* = Presenting author
Objectives: The main objective of the thesis was to describe symptom load experienced in a population and in general practice. Further aims were to assess the way in which GPs’ evaluate symptoms as medically unexplained, and patients’ attribution of symptoms to “unexplained” conditions.
Background: Self-reported symptom load is associated with future functional ability and disability pensioning. Paradoxically, symptom load is rarely focused upon in the medical curriculum and research.
Results: One third of patients and one sixth of respondents in the population reported at least ten symptoms. Women reported significantly more symptoms than men.

In the population, there was a strong and almost linear relationship between symptom load in the two symptom categories. The number and type of symptoms provided comparable information.

GPs used the whole Multi- and MUS-scales in evaluating patients, and the scales showed substantial agreement.

Nearly 40% of the patients had considered that they suffered from at least one unexplained condition. The proportion increased linearly with symptom load and the number of life stressors.

Material/Methods: The thesis is based on 2004 data from the Ullensaker population study, and a general practice study linking patient and GP questionnaires. In the Ullensaker study, the relationship between two symptom categories (the number of pains sites and the number of other common symptoms) were explored. In the general practice study, two scales were compared, representing GPs’ evaluation of symptoms as unexplained (MUS-scale) and/or multiple (Multi-scale). Patients recorded the number of symptoms experienced, negative life events and whether they considered that they suffer from unexplained conditions.
Conclusion: In both the population and in general practice setting, a high self-reported symptom load is common and is an important health indicator. Regardless of symptom type, internal associations may be found between symptom categories, if they are looked for.

MUS has been found to be a concept which is hard to operationalise in research. Symptom load seems to be an acceptable proxy for MUS. It is best operationalised as a continuous variable.

Points for discussion: In general practice, most patients with multiple symptoms do not meet the criteria for existing syndrome diagnoses. A descriptive term to capture patients’ symptom load is needed, as most existing diagnoses capture single symptoms only.

Clinical work calls for a pragmatic dichotomisation of health and disease. However, in symptom research, and other research exploring unresolved fields, the use of continuous outcome measures is a fruitful approach.