G261(P) How confident do paediatricians feel in managing medically unexplained symptoms?. (25th October 2020) - Hoddes, J
Abstract : Aims: This survey was designed to explore the experience and confidence of Paediatricians in the management of children and young people with Medically Unexplained Symptoms (MUS). Methods: Semi- structured questionnaires using mostly closed ended questions regarding clinicians' experience of managing cases of MUS and their confidence in managing such cases were distributed to all middle grade doctors and consultants working in acute and community paediatrics within our trust Results: 17 completed questionnaires were analysed: 6 Middle Grade Doctors (MGD); 7 Hospital Consultants (HC) and 4 Community Consultants (CC). Data was subcategorised and frequencies of responses determined. 5/17 respondents, all hospital based, reported seeing children with MUS on a monthly basis. 5/17 respondents were confident in making a diagnosis of MUS (4 hospital and 1 community consultant). All Middle Grade Doctors did not feel confident in diagnosing MUS and all but one Middle Grade respondent felt uncomfortable discussing MUS with patients and families. 9/17 ( 53%) of respondents strongly agreed with having an end point for investigations with 5 out of 9 respondents being hospital consultants. Hospital Consultants and Middle Grade Doctors tended to believe that it was their role to rule out a physical cause before addressing mental health issues however Community Consultants were less likely to agree with this view. The general trend amongst Paediatricians was towards sharing uncertainties about the diagnosis with the family but there was a diverse range of opinion on this irrespective of workplace or level of experience. All groups would raise the possibility of MUS with colleagues earlier than they would with the families. Consultants (HC and CC) were generally likely to pre-empt normal test results with the family. Community Consultants were the group most likely to feel that they had already received some training in MUS, however, several CC confused the diagnosis of MUS with Factitious Induced Illness in their comments. Conclusions: MUS causes high levels of morbidity within the paediatric population; however, our survey has shown that many Paediatricians of all levels do not feel confident in managing MUS. We advocate that training in Medically Unexplained Symptoms is mandatory for all Paediatricians.