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.