Outcome in general medical patients presenting with common symptoms: a prospective study with a 2-week and a 3-month...

Although physical complaints account for over half of all ambulatory visits, surprisingly little is known about their natural history and factors affecting prognosis.

Our aims were to determine the outcome in general medical patients presenting with physical complaints and to delineate which factors impact upon recovery rates.

In this cohort study, 500 adults presenting to a general medicine clinic with a chief complaint of a physical symptom were interviewed in order to determine symptom characteristics, the presence of depressive or anxiety disorders, and expectations regarding the visit. Outcomes were assessed immediately post-visit and at 2 weeks and 3 months. The primary outcome was symptomatic improvement, and secondary outcomes included functional status, unmet expectations, satisfaction with care and visit costs.

The majority (70%) of patients improved by 2 weeks follow-up and, of those who had not, 60% got better within 3 months. Moreover, relapse in patients initially better at 2 weeks was uncommon (6%) in the ensuing several months. While symptoms of recent onset had the highest improvement rates, half of those patients whose symptom had been present a year or longer also improved within 2 weeks. Improvement rates varied somewhat by symptom type, but no specific symptom had an improvement rate of less than 50%. Patients who had not improved at 2 weeks were more likely to report continuing serious illness worry, unmet expectations, functional impairment and dissatisfaction, even 3 months after the initial visit.

Most general medical patients with physical complaints improve within 2 weeks of their initial clinic visit. Further attention may best be focused on the minority of patients who fail to improve and experience continuing concerns and impairment.