How to deal with Medically Unexplained Symptoms (MUS)

We talk about medically unexplained symptoms (MUS) when someone is struggling with physical symptoms that last for more than just a few weeks and where a medical examination does not reveal any physical cause that fully explains the symptoms. Factors that may be involved in a long-term absence due to MUS are disproportionate worrying (hypochondria), age and working in the non-profit sector.

The age factor is present because older employees are more frequently referred by doctors for additional tests, following the motto "better safe than sorry". This can create worry, which makes people avoid doing certain things. But it is precisely for this group of employees where it is important to keep active at work, with suitable job activities and more rapid reintegration. This way they can remain active, which helps promote their general well-being.

The non-profit sector incurs a higher risk because this sector has a much less open culture between managers and employees. A person with symptoms can therefore rapidly end up in a situation of absenteeism and even incapacity for work. There is also not enough incentive to remain active and working if it is only part-time. You can avoid this kind of situation by means of open communication about resilience and fitness for work, and discussing it regularly with your employees.

Employees who miss work because of ailments for which there is no obvious cause, are at risk of long-term absences and even incapacity for work. A 60-year old middle-school teacher, for example, given the risk factors described above, faces a high risk that his or her reintegration makes little progress, and they end up on long-term sick leave. The longer someone is away from work, and the longer they receive no support, the more difficult it becomes for them to return to work.

As a manager, you always leave the diagnoses and treatments to a professional. They will first investigate whether there is a physical medical cause for the symptoms. Then they will seek a psychiatric explanation for the symptoms, such as depression or an anxiety disorder. If this is not the case either, then they will investigate whether factors such as worrying, extreme sensitivity to physical symptoms, work or private problems could explain the symptoms.

It is important if a treatment is to succeed that there is understanding of the symptoms and acceptance of the fact that employee really does suffer from them. Empathy helps, as does someone who involves the employee in seeking an underlying explanation that the employee themselves will understand.

Sometimes an employee will blame their physical symptoms on the working environment. Remember when sick building syndrome was in the news a few years ago? Here too, the first step is: take the symptoms seriously, and rule out any real causes in the working environment. An external expert can help with this. As a next step, it is also important to check whether the pressure of work and working atmosphere might be playing a part, and need attention. You as a manager can get these things investigated. Usually in this case there will be several employees who have complained that they are suffering from pressure of work, alternatively a rise in the percentage of absences due to illness can indicate this.

MUS is really more of a working hypothesis for the person providing treatment than a useful concept for the employee who is suffering from it. You therefore do not need to use this term when speaking to your employee. As a manager it is important that you always refrain from any judgements or explanations.

You can help best by showing understanding, letting people see that you sympathise and by keeping your employee involved in work and with colleagues. Showing empathy has been proven to effectively create a better basis for treatment and reintegration. As a manager you will be involved intensively in their reintegration, if only because of the steps required by the Improved Gatekeeper Law. You will have regular contact with your employee in order to discuss the progress of their reintegration. Leave enough time for this, and keep your employee involved in what is going on and in seeking solutions. This can be done by phone if it has been agreed that the person cannot come to work for a while. If you find it difficult to decide when you should or should not be in contact, or you are not sure how to manage the conversation, ask for help with this.

If you get the feeling that the reintegration is not making any progress, do not hesitate to involve others to help. Talk to the company doctor, including if you need help yourself.

The following book was used to help in writing this article: From burnout to resilience by Rob Hoedeman.