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Patients with medically unexplained physical symptoms (MUPS) may present frequently to hospital settings and receive potentially unnecessary investigations and treatments.
A sample of 49 patients was drawn and their handwritten and electronic clinical records were examined in detail to extricate all MUPS-related secondary care activity within six months of the MUPS presentation (emergency department, inpatient stays, outpatient appointments, and all associated investigations, procedures and medications).
We aimed to assess the frequency and type of MUPS presentations to clinical services and estimate the associated direct healthcare costs.
This study was undertaken at Waitemata District Health Board (WDHB), the largest DHB in New Zealand. All patients with a diagnosed presentation of MUPS in 2013 were identified using the WDHB clinical coding system. Their clinical records were screened to select all patients who matched the study inclusion and exclusion criteria. Standardised national costing methodology was used to calculate the associated healthcare costs.
Forty-five percent of patients presented to hospital settings at least twice over the one-year timeframe. The most common diagnoses were non-epileptic seizures (31%) and hyperventilation syndrome (30%). The total cost for the sample was NZ$179, 271 (mean NZ$3659). Costs were most significant in the areas of inpatient admissions and emergency care.
MUPS can result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving the recognition and management of MUPS has the potential to offer more appropriate and cost-effective healthcare nationally and internationally.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Graduate entry medical students’ views of psychiatry may differ from those of school leavers. This study hypothesised that (i) exposure to a psychiatry attachment is associated with a positive change in attitudes towards psychiatry in both graduate entry and non-graduate entry students, (ii) graduate entry students exhibit a more positive attitude to psychiatry compared to non-graduate entry students and (iii) graduate entry students are more interested in a career in psychiatry than non-graduate entry students.
In this study 247 medical students (118 females and 129 males) completing their psychiatry rotation were invited to complete questionnaires examining career choice, attitudes to psychiatry and career attractiveness for a range of specialties including surgery, medicine, general practice and psychiatry before and after their psychiatry attachment. Questionnaires were distributed prior to commencement of their attachment and redistributed on the final day of the attachment.
Of the 165 participants in the study, 75 students entered medicine via the traditional route (without a primary degree), 49 entered via the graduate entry programme and 41 had a primary degree. Overall, medical students displayed positive attitudes towards psychiatry. However, while there was an improvement in attitudes towards psychiatry and the career attractiveness of psychiatry on completion of the rotation, no differences were found between graduate and non-graduate entry students. Psychiatry and general practice had lower ratings for career attractiveness than other specialities. No significant changes were found in the first and second choice of specialty.
Our results show that improvements in attitude and career attractiveness do not necessarily correlate with increased choice of psychiatry as a specialty. Graduate entry has been considered a possible opportunity for increasing recruitment in psychiatry but our results suggest that this may not be the case. Follow-up studies are required to determine whether career attractiveness correlates with future career choice.
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