Patterns of referral in patients with medically unexplained motor symptoms

Objective: To investigate the pattern and reasons for referrals in 64 patie nts with a stable diagnosis of motor conversion symptoms who had been asses sed at the National Hospital for Neurology and Neurosurgery (NHNN). Method: Patients were interviewed on average 6 years after their original admissio n to the NHNN. Hospital notes and GP records were consulted. Results: Psych iatrists at the NHNN saw 75% of patients. Treatment was initiated in 60% of these, During the 6-year follow up, many patients continued to be referred to neurologists and other specialists, but subsequent psychiatric referral was rare. Many changed their GP after discharge from the NHNN and a dispro portionate number of re-referrals was made by GPs who had known their patie nts for less than 6 months. Psychological attribution of symptoms was rare and did not appear to be related to the pattern of referrals. Conclusion: T he pattern of care of these patients was inconsistent and many felt dissati sfied with the treatment they received. This led to further referrals, unne cessary use of valuable resources and unnecessary exposure to iatrogenic da mage. Further studies should aim to assist GPs and other clinicians in deci ding when referral is likely to be beneficial. (C) 2000 EIsevier Science In c. All rights reserved.