Table 3 Quotes of FPs in relation to the recognition of MUPS

FG5;FP5: ‘I believe I know what is going on within 30 s, like many of us. When I think within 2 min “I do not have a clue of what is going on here”, then I start to think “This can be MUPS”.’

FG5;FP3: ‘Well, we all know the consultation where things go as you have planned. You do what you always do, start with taking history, then physical examination, then you often have a diagnosis and then you discuss the strategy. But with MUPS patients, what I usually notice is that the discussion does not go so well and you switch between phases. And you think, what is going on? That is a first possible recognition clue.’

FG2;FP1: ‘When someone consults me with chest pain during exercise that disappears after 2 min at rest, that is something completely different from when they present many complaints and we often call them atypical, right? It does not fit with a specific disease. They have a headache, but when you talk about the headache they also have back pain and when you are finished with the back pain, they also feel tingles and with everything together, it just does not make sense.’

FG4;FP5: ‘A long list of episodes.’

FP1 and FP4: ‘Yes.’

FP3: ‘A long history…’

FP5:’…Without any serious diseases.’

FP2: ‘With many referrals for additional examinations or to specialists.’

FP1: ‘They remain at the complaint level, like headache or stomach ache or fatigue or dizziness.’

FG1;FP1: ‘I often use it as a diagnostic tool for MUPS, that I get irritated by patients.’

FG4;FP1: ‘What I notice is that many doctors have the same basic feeling about these patients and how they recognize them: the exhaustion, the desperation of the doctor and the way they easily get into a fight with these patients.’