A 33-year-old woman has had repeated unexplained physical symptoms across several systems for years, with normal investigations, and asks for further scans. What is the best approach in primary care?
Answer and explanation
Correct answer: A. Acknowledge her symptoms, agree a limited investigation plan and offer regular scheduled reviews with one clinician
- Step 1: This pattern suggests a somatic symptom disorder and needs a consistent, validating approach.
- Step 2: Regular review with a single clinician limits repeated investigation and builds trust.
Answer
Acknowledge her symptoms, agree a limited investigation plan and offer regular scheduled reviews with one clinician.
Why not the others: Request every scan she asks for, to avoid any possible complaint: Unnecessary tests carry risks and reinforce anxiety. Prescribe long-term opioid analgesia to cover each of her symptoms: Opioids carry harm and do not treat the underlying problem. Tell her the symptoms are imaginary and discharge her from the practice: Dismissing her harms the relationship and may miss new disease.
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