Case studies


Lynda is a middle aged woman in full time employment visiting her GP for consultations lasting on average 36 minutes each time. Lynda visited her GP at least 13 times per year over two years.

Lynda presented as tense, a “bundle of nerves” and complaining of muscular cramps, insomnia, headache and feeling low and tired. She often visited A&E with headaches and muscular cramps. Lynda’s symptoms began after a traumatic event in the past. Since then whenever stressful situations arose in everyday life she had panic attacks and could not function or self-manage. She was unable to sleep well, found it hard to go to work as she felt tired and could not concentrate which resulted in frequent absences from work. Lynda’s GP was unsure whether she needed investigations however sent her for two scans and for several different blood tests. It was made clear to the patient by the GP that the investigations would probably come back negative. CBT was discussed with Lynda but she was reluctant to attend as she insisted on a physical explanation for her symptoms not wanting to consider a psychological one. The frequent referrals for tests and scans increased her belief that there would be a physical, medical explanation which just had not been discovered as yet. Her reluctance to engage with psychological therapies was based on her fear that she would be given a mental health label. She explained her depression as being concerned with a reaction to the lack of medical explanation. Lynda received consistent advice within the practice GPs in the practice as they were all aware of Lynda and the fact that her symptoms were medically unexplained.

Lynda’s GP continued to discuss the case with fellow GPs and other specialist colleagues at formal clinical meetings that supported the difficult decision of not referring for any more tests or investigations.

Lynda’s GP explained to her why referrals for investigations were no longer going to be made and discussed with her the idea of attending a supportive group treatment (The MUS Clinic) focusing on her symptoms and quality of life as being helpful in the meantime.

Lynda’s GP used the Pathways2Wellbeing consultation document for GPs in order to give her the relevant Information and answer queries which enabled her to participate in a shared decision-making process to attend the group.

Lynda attended 10 out of the 12 MUS clinic sessions. She began to explore her breathing patterns through various exercises.  She soon realised something was different and discovered the correct way of breathing and practised it frequently. In the group Lynda looked happier, seemed more energised and reported to the facilitator and group that she was now sleeping better and enjoying work. Lynda said that the new breathing pattern had become second nature to her and she appeared to increase in confidence at every session. Through the bodywork practices Lynda found that she was well co-ordinated and gracious in her movement, had a good sense of rhythm and could dance!

Lynda now enjoys dancing around in her kitchen pain-free! She has reported six months later that the group experience changed her life. Lynda has not needed to return to her GP or A&E again for these symptoms and enjoys a better quality of life. When Lynda’s symptoms return, which they do from time to time, the bad days are not so bad and she can self-manage them so that she feels far more in control. Lynda’s medication for depression and pain relief are reduced to almost nil.

As a result of the reduced number of appointments and time spent discussing Lynda’s case there has been increased capacity for her GP and his colleagues. This means that they have been freed up to see other patients that they can help. The costs for tests and scans have been significantly reduced as the patient no longer requests these. Medication costs have also been reduced considerably. A&E visits have stopped altogether reducing costs to the surgery. The frustration felt by the GP in being unable to help Lynda has disappeared, improving their quality of life and job satisfaction. Lynda only visits the surgery on occasion now for different conditions with organic explanations.