Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study

Objective: To estimate the prevalence of medically unexplained symptoms in patients who most frequently attend outpatient services. Design: Retrospective cohort study over three years with review of case notes. Setting: Secondary care services in the South Thames (West) NHS region. Participants: Outpatient attenders with new appointments in 1993. Main outcome measures: Number of outpatient appointments, and number of consultation episodes for medically unexplained conditions. Results: Medical records of 361 of 400 sampled frequent attenders were examined, and 971 consultation episodes were recorded. Ninety seven (27%) had one or more consultation episodes in which the condition was medically unexplained; 208 (21%) of the 971 consultation episodes were medically unexplained. Abdominal pain, chest pain, headache, and back pain were commonly found to be medically unexplained. Conclusions: Medically unexplained symptoms present in most hospital specialties and account for a considerable proportion of consultations by frequent attenders in secondary care. What is already known on this topic Frequent attenders in all medical settings account for a disproportionate amount of healthcare resources In primary care, frequent attenders commonly present with symptoms that remain medically unexplained What this study adds Medically unexplained symptoms are also common among frequent attenders in secondary care and present in most specialties Symptoms that are particularly likely to remain unexplained in this group include gastrointestinal complaints, back pain, and headache