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Clinical practitioners’ views on the management of patients with medically unexplained physical symptoms (MUPS): a qualitative study
  1. A Keith W Brownell1,
  2. Chloe Atkins2,
  3. Andrea Whiteley3,
  4. Robert F Woollard4,
  5. Jude Kornelsen4
  1. 1Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
  3. 3Graduate Program in Communication and Media, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
  4. 4Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr A Keith W Brownell; akwb{at}


Objectives By identifying strategies that practicing physicians use in managing patients with medically unexplained physical symptoms (MUPS), we present an interim practical management guide (IPMG) that clinical practitioners may find useful in their clinical practices and that may help guide future research.

Design A qualitative research study based on interview data from practicing physicians with experience in dealing with MUPS and known to the physician members of the research team. A parallel exploration of patient experiences was carried out simultaneously and is reported elsewhere.

Setting 2 urban centres in 2 different Canadian provinces in a healthcare system where family physicians provide the majority of primary care and self-referral to specialists rarely occurs.

Participants The physician members of the research team invited practicing family and specialty physicians to participate in the study.

Results We characterise the care of patients with MUPS in terms of a 4-part framework: (1) the challenge of diagnosis; (2) the challenge of management/treatment; (3) the importance of communication and (4) the importance of the therapeutic relationship.

Conclusions On the basis of the details in the different parts of the framework, we propose an IPMG that practitioners may find useful to facilitate the clinical care of patients with MUPS. The guide can be readily implemented into the practice of any physician who cares for patients with MUPS.

  • MUPS
  • Qualitative research study
  • Management guide
  • Diagnostic approach
  • Diagnostic strategy.

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  • Contributors JK and CA conceived and designed the study in collaboration with AKWB and RFW. JK and RFW conducted the interviews in centre A and AKWB, CA and AW conducted the interviews in centre B. All authors had full access to the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding Canadian Institute of Health Research Catalyst Grant Ethics # 245787.

  • Competing interests None declared.

  • Ethics approval Ethics Committees at the University of British Columbia and the University of Calgary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.