MEDICALLY UNEXPLAINED

SUMMARY:  Most clinicians deal daily with medically unexplained symptoms, which also occur in a significant minority of personal injury litigators' clients.  The way physicians talk with their patients about such symptoms can trigger ill-advised Actions for medical malpractice.  Commonly, medically unexplained symptoms need to be excluded in assessing personal injury Damages.

Prevalence

Primary care physicians report that about a fifth of their patients have physical symptoms that are medically unexplained;  self-report screening tests suggest that the number of patients with multiple unexplained physical symptoms is nearer one in three, with 5% probably suffering from Somatisation Disorder.1

About a quarter of frequent attenders for medical specialist services have unexplained symptoms.2 Full Text Cross-cultural studies by the World Health Organisation indicate that the phenomenon is likely universal. 3, 4

Although prevalence studies have not as yet been undertaken in personal injury litigation populations, my personal professional experience in consulting on 3500 cases suggests that medically unexplained symptoms occur in at least a quarter of litigants and are medicolegally relevant in about half of those cases. 

Medicolegal Implications

The way physicians talk with their patients about such symptoms can trigger ill-advised Actions for medical malpractice. 

The following iatrogenic factors 5 Full Text are frequent triggers of ill-advised medical malpractice Actions. 

Practical Pointer

Iatrogenic factors in the development of medically unexplained symptoms: 5 Full Text

  • Physician uncertainty and inability to provide an explanation
  • Failure to convince patient that the complaint is accepted as genuine
  • Reassurance without a positive explanation
  • Ambiguous and contradictory advice
  • Excessive investigation and treatment

Commonly, medically unexplained symptoms need to be excluded in assessing personal injury Damages.

Even in viable Personal Injury Actions in general, and medical malpractice cases in particular, the potential Quantum of Damages may be reduced, sometimes drastically, because of symptom misattribution. 

Practical Pointer

Some common functional symptoms and syndromes: 5 Full Text

  • Muscle and joint pain (fibromyalgia)
  • Low back pain
  • Tension headache
  • Atypical facial pain
  • Chronic fatigue (Myalgic Encephalomyelitis)
  • Non-cardiac chest pain
  • Palpitation
  • Non-ulcer dyspepsia
  • Irritable bowel
  • Dizziness
  • Insomnia

Conversely, if review of the pre-injury clinical records confirms that the medically unexplained physical symptoms are of new onset, directed psychiatric Independent Medical Examination and expert opinion may provide Causal evidence through mechanisms of psychological injury. 

Copyright © 2008 Electronic Handbook of Legal Medicine