Breaking barriers in the education of persistent physical symptoms.

Persistent physical symptoms (PPS) account for around 45% of all primary care consultations, and are associated with significant disability and costs. While not always the case, co-existent mental health difficulties can often present alongside PPS. Individuals suffering from PPS may present with psychological symptoms such as rumination and catastrophising, as well as early adverse childhood events. Research has shown that adequately understanding and managing psychological factors associated with PPS can prevent symptoms from being more chronic and disabling. Adequate education therefore is vital for medical students and doctors, particularly GPs, such that they are able to manage PPS in a professional, knowledgeable and patient-centred manner. At present there exist several barriers to such education - including curriculum overload and a lack of alignment with the current structure of medical school, whereby physical and mental health are often taught in separate blocks. We suggest several ways in which barriers can be broken, such that GPs feel more empowered to manage patients with PPS. These include a greater emphasis on the psychological dimensions of illness from an early stage in medical school, an improved framework for taking a history from patients with PPS, more exposure to case studies and real-life patient experiences of PPS, narrowing the gap between theoretical teaching and the realities of the workplace, including importantly highlighting multidisciplinary working and improved education around communicating effectively with patients with PPS. We hope that by breaking these barriers, doctors can feel more able to enquire about, understand and manage PPS, ultimately leading to better outcomes for patients.