Qualitative Health Research 1–11 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732315578400 qhr.sagepub.com Article Medically unexplained illnesses (MUI) are characterized by a cluster of unexplained medical symptoms that meet the diagnostic criteria for a recognized unexplained ill- ness (Dumit, 2005). Illnesses such as Gulf War Syndrome (GWS), Chronic Fatigue Syndrome (CFS), Fibromyalgia Syndrome (FM), and Multiple Chemical Sensitivity (MCS) are examples of MUI and are often chronic and lack a definitive biological basis, diagnosis, treatment, and prognosis (Dumit, 2005). Patients with MUI and with medically unexplained symptoms (MUS) often report having difficult experiences with the medical community (Bieber et al., 2006; Dumit, 2005; Reid, Whooley, Crayford, & Hotopf, 2001; Swoboda, 2008). The main distinction between MUI and MUS is that whereas MUS are characterized by one or more physical symptoms, unlike MUI, they do not fit with diagnostic criteria for a recognized unexplained illness and cannot be explained by corresponding physical pathology (Swanson, Hamilton, & Feldman, 2010). Researchers have esti- mated that approximately 25% to 50% of patients seen in primary care present with MUS, which makes MUS the most common set of complaints seen by primary care providers (Edwards, Stern, Clarke, Ivbijaro, & Kasney, 2010). In addition, people with either MUS or MUI tend to be higher utilizers of health care services and have sig- nificantly greater health care costs than other patients (Burton, McGorm, Richardson, Weller, & Sharpe, 2012; Reid et al., 2001), which can add stress and strain for the patient, family, provider, and other members of the patient’s health care team (Gibson, 2006). Through a systematic review of the literature (Harsh, Hodgson, White, Lamson, & Irons, 2013), we found that medical providers varied greatly in their thoughts about MUI/S, including the diagnoses given (Steven et al., 2000), treatment protocols applied (Cho, Menezes, Bhugra, & Wessely, 2008), decision-making strategies used (Phillips, 2010; Swoboda, 2008), and attributed causes for their development. Psychosocial attributions (i.e., a pessimistic view of life; Asbring & Narvanen, 2003), biomedical attributions (i.e., immune system dys- function; Denz-Penhey & Murdoch, 1993), or a combina- tion of psychosocial and biomedical factors (Gibson & Lindberg, 2011; Phillips, 2010) were each discussed, but 578400QHR XX X 10.1177/1049732315578400Qualitative Health ResearchHarsh et al. research-article 2015 1 University of Nebraska Medical Center, Omaha, Nebraska, USA 2 East Carolina University, Greenville, North Carolina, USA 3 Northcentral University, Prescott Valley, Arizona, USA Corresponding Author: Jennifer Harsh, University of Nebraska Medical Center, 139 South 40th Street, Omaha, NE 68131, USA. Email: jenharsh@gmail.com Medical Residents’ Experiences With Medically Unexplained Illness and Medically Unexplained Symptoms Jennifer Harsh 1 , Jennifer Hodgson 2 , Mark B. White 3 , Angela L. Lamson 2 , and Thomas G. Irons 2 Abstract Patients who present with medically unexplained illnesses or medically unexplained symptoms (MUI/S) tend to be higher utilizers of health care services and have significantly greater health care costs than other patients, which add stress and strain for both the patient and provider. Although MUI/S are commonly seen in primary care, there is not sufficient information available regarding how providers can increase their level of confidence and decrease their level of frustration when working with patients who present with MUI/S. The goal of this article is to present findings from a qualitative phenomenology study, which highlights medical residents’ experiences of caring for patients with MUI/S and the personal and professional factors that contributed to their clinical approaches. Results from these studies indicate that residents often experience a lack of confidence in their ability to effectively treat patients with MUI/S, as well as frustration surrounding their encounters with this group of patients. Keywords health care professionals; phenomenology; relationships, patient–provider; psychosocial at East Carolina University on March 27, 2015 qhr.sagepub.com Downloaded from