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.