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- Page navigation anchor for Simply exhausted - a useful diagnosis in general practiceSimply exhausted - a useful diagnosis in general practice
We regularly see patients with unclear symptoms whom we consider being exhausted. When several of these features are present they can explain why the person is exhausted, and the suggestion ‘you are exhausted’ is plausible and acceptable to the patient. This is another helpful strategy for appropriate patients with medically unexplained physical symptoms,1 another explanation which we can provide.2
Features suggesting possible exhaustion based on 30 years’ experience as a GP
- rarely taking adequate holidays;
- long hours, especially when travelling is included;
- seven-day-a-week working;
- often high-achievers;
- carrying a work mobile phone when ‘not working’;
- self-employment, especially ‘over the shop’ businesses;
- dependent elderly relatives 8. studying for educational qualifications whilst working;
- no time for creative leisure – any leisure time is spent watching TV;
- agreement when exhaustion is suggested.
We gave a brief questionnaire to 40 local GPs to ask if they considered exhaustion as a diagnosis separately from depression or stress? Most (68–100%) GPs agreed on a likely diagnosis of exhaustion, rather than depression, for each of five vignettes.
Guidelines may forget social issues as a cause of tiredness, but exhaustion appears to be a recognised diagnosis by GPs. Active f...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Helpful strategies for GPs seeing patients with MUPSHelpful strategies for GPs seeing patients with MUPS
I read with interest the article by the Norwegian research group. I have only recently become aware of the diagnostic label, MUPS, despite suffering from such symptoms for over 40 years.
In 1975, I was prescribed nitrazepam for myoclonic epilepsy and suffered an adverse reaction to the drug which went unnoticed by doctors. I tried to commit suicide and was referred to psychiatry. I consumed antidepressants for 40 years. I discussed my symptoms ad nauseam with countless doctors for four decades. I cannot fault the amount of time that was spent with me at great cost to the NHS. I also suffered from IBS symptoms for 10 years. Exclusion diets and tablets made no difference. I then consulted a chiropractor who resolved my IBS problems in 6 weeks. My spine had been pressing on the nerves leading to the gut.
Six months later I was advised by my GP to stop taking nitrazepam. It very soon became clear that I do not suffer from depression and have not suffered from it for decades. My brain had been suppressed by the drug resulting in many MUPS. I am now disabled physically and cognitively due to a horrendous withdrawal but am unable to achieve a diagnosis of protracted benzodiazepine withdrawal syndrome or other accurate description of my condition. Other diagnostic labels are preferred which do not implicate the drug. And so most of my adult life has been devastated by prescription drug side effects. My doctors adopted all the strategies sug...
Competing Interests: None declared. - Page navigation anchor for Focus groups for MUPS-labelled patients about seeing their doctors?Focus groups for MUPS-labelled patients about seeing their doctors?There seems to have been a concerted focus in recent months on educating GPs about managing patients with medically unexplained physical symptoms (MUPS). Now this focus group study is published, with the focus groups comprised of GPs from continuous medical education (CME) groups who were awarded CME credit points for taking part in the study.It would be most interesting if the authors would to do a parallel study with focus groups comprised of patients regarded as having MUPS, exploring what their patient experience is of seeing doctors who consider that they have MUPS. Perhaps the patients could be awarded some sort of continuing patient participation (CPP?) credit points for taking part?The patient e-letter responses to Rachel Pryke's letter 'Why are MUS conflated with heartsink' 1 in the June 2017 BJGP give some indication of factors that may be of importance to patients.The rapid responses to the recent BMJ editorial 'Judging the benefits and harms of medicines' 2 are also relevant to discussions about MUPS as these relate to 'trust', clinical evidence and the doctor/patient relationship - which last, as the focus group MUPS study acknowledges, tends to become strained in MUPS cases when patients and doctors can experience frustration and dissatisfaction.In the spirit of continuing doctor ed...Show MoreCompeting Interests: None declared.