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Review: Many Common Symptoms Unrelated to Disease

Disease-focused model of care may be inadequate for symptom-prompted outpatient visits

TUESDAY, Oct. 21, 2014 (HealthDay News) -- At least one-third of common symptoms have no disease-related explanation, according to a narrative review published in the Oct. 21 issue of the Annals of Internal Medicine.

Noting that physical symptoms account for more than half of all outpatient visits, but that the main disease-focused model of care is inadequate for many of these visits, Kurt Kroenke, M.D., from Indiana University in Indianapolis, reviewed epidemiological questions relating to clinical conditions.

The author notes that a clear-cut disease-based explanation is lacking for at least one-third of common symptoms. History and physical examination contribute most diagnostic information, with a smaller contribution for testing and procedures. A dualistic approach is impractical as physical and psychological symptoms often co-occur. Most patients have multiple symptoms, and doctors should not treat only one symptom. In most patients, symptoms improve in weeks to months, but in 20 to 25 percent of patients they can become chronic or recur. During long-term follow-up, serious causes that were not apparent after initial evaluation rarely emerge. Some behavioral and pharmacological treatments are effective for multiple symptoms. Valid scales can be useful for measuring treatment response. Communication has therapeutic value, including in terms of providing an explanation and possible prognosis.

"The amount of clinician training dedicated to understanding, evaluating, and managing common symptoms is disproportionally small relative to their prevalence, impairment, and health care costs," the authors write.

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