Medically unexplained symptoms (MUS), defined as symptoms lacking objective test findings or known biological causes, are highly prevalent and pose significant challenges for healthcare providers. Often associated with complex biopsychosocial origins, MUS can lead to diagnostic uncertainty. Consequently, providers may rely on patient characteristics, such as gender and mental health history, when making a diagnosis or determining appropriate treatments, which may introduce bias into their decision-making. This study investigated how these factors influence provider decision-making in diagnosing and treating MUS, focusing on two key research questions: (1) How does knowledge of a patient’s gender and mental health history affect diagnostic assessment? And (2) How does it impact treatment likelihood?
A sample of 152 primary care providers participated in the study, through an online survey, which implemented a 2x2 factorial between-subjects design. Participants were randomized into one of four conditions and reviewed clinical case vignettes, responding to questions regarding diagnostic and treatment considerations. The findings revealed a significant effect of patient gender and mental health history on treatment decisions. Providers were less likely to recommend medical follow-up for female patients with a history of depression and anxiety compared to male patients without a history of mental health concerns. For symptoms specifically involving generalized pain and fatigue, providers were more likely to attribute them to behavioral health factors than medical causes in female patients with histories of depression and anxiety compared to other groups. Conversely, for patients without a mental health history, providers favored medical follow-up over behavioral health interventions, regardless of patient gender. No significant differences emerged for diagnostic assessment or behavioral health treatment recommendations across groups.
These results suggest that patient gender and mental health history influence provider decision-making regarding the management of MUS, highlighting the need for strategies to reduce bias and improve equity in clinical decision-making. Additional research is warranted to explore these relationships further and better understand how various factors impact the assessment and treatment of ambiguous symptoms.