[The Dutch multidisciplinary guideline entitled 'Medically unexplained physical symptoms and somatoform disorder'].Ned Tijdschr Geneeskd. 2011; 155(18):A1244.NT
The Dutch multidisciplinary guideline called 'Medically unexplained physical symptoms (MUPS) and somatoform disorder' presents a disease-management approach based on three pillars: (a) maintaining patient profiles estimating the risk of iatrogenic harm as well as chronicity, (b) stepped-care treatment starting at a level appropriate for the patient's profile, and (c) the introduction of the family physician as case manager (in serious cases: the medical specialist or psychiatrist) whose task is to channel use of the health care system. Patients with a 'minor risk' profile require psycho-education and two-track treatment by the family physician. The 'moderate risk' profile is complicated by co-morbid depression, anxiety disorder or a somatic disorder; the prognosis is favourable when this co-morbidity is treated. The 'serious risk' profile is assigned to patients with long-term somatoform disorders and a history of surgery for MUPS in addition to disturbed patient-doctor relationships. Limiting iatrogenic harm is of highest priority in these patients. Implementation should focus on providing access to care as described in the guideline.