Programme no. 421-OP
Professional Development
“So if my tests are negative, what is causing my symptoms?” Towards a rational explanation.
Aase Aamland*1, Peter Lucassen2, Chris Burton3, Tim Olde Hartman4
1Research Unit for General Practice, Uni Research Health,Bergen,Norway, 2Department of Primary & Community Care, Radboud University Nijmegen Medical Center,Nijmegen,Netherlands, 3Division of Applied Health Sciences, University of Aberdeen,Aberdeen,United Kingdom, 4Department of Primary & Community Care, Radboud University Nijmegen Medical Center,Nijmegen,Netherlands
* = Presenting author
Objectives: To present our newly published essay: “Explaining symptoms after negative tests: towards a rational explanation”(1).
Background: Medically unexplained symptoms (MUS) are highly prevalent in primary care. Sustained reassurance does not automatically follow from negative diagnostic tests, and patients who continue to consult their general practitioner (GP) are likely to receive further, possibly unnecessary tests, and treatments.
Results: Building on earlier research, we propose these six characteristics of a rational explanation:

(1) it is plausible (to both doctor and patient; (2) it does not imply weakness or fault on the part of the patient; (3) it promotes therapeutic partnership or action; (4) it applies a descriptive label (which need not be a specific diagnosis); (5) it addresses causation, although this may be through perpetuating mechanisms rather than root cause; and, finally, (6) it is created through dialogue between doctor and patient.

Material/Methods: We argue that clinicians can provide acceptable explanations for symptoms, which persist after ruling out known physical disease and that this is a necessary counterweight to the power of diagnostic testing. We examine explanations from the perspectives of patients and clinicians and consider the different ways of explaining symptoms following negative tests.
Conclusion: GPs need to become more skilled in suggesting explanations for persistent MUS after negative diagnostic tests. Our proposed rational explanation can be used as a guide with whom GPs can help their patients find meaningful explanations. There is a need for more research into effective explanations for MUS.
Points for discussion: Discussion of some practicebased examples of rational explanations.

1. Burton C, Lucassen P, Aamland A, Hartman TO. Explaining symptoms after negative tests: towards a rational explanation. J R Soc Med 2014.

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