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Onverklaarde lichamelijke klachten

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Huisarts en wetenschap Aims and scope

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Olde Hartman TC, Van Ravesteijn H, Lucassen P. Onverklaarde lichamelijke klachten. Huisarts Wet 2012;55(7):301-5.

De huisarts wordt vaak geconfronteerd met patiënten met somatisch onvoldoende verklaarde lichamelijke klachten (SOLK). Slechts een minderheid (2,5%) van deze patiënten houdt chronisch last van deze klachten, maar die minderheid doet wel een groot beroep op de gezondheidszorg. Veel huisartsen vinden de behandeling en begeleiding van patiënten met chronische SOLK moeilijk, met name het geven van goede en concrete uitleg. Om de arts-patiëntrelatie in stand te houden vallen huisartsen terug op zorgrituelen, zoals het inplannen van regelmatige contacten. Veel huisartsen hebben een contraproductief beeld van patiënten met SOLK. Het idee dat patiënten druk uitoefenen op de huisarts voor het krijgen van somatische interventies klopt niet, evenals het idee dat patiënten met SOLK niet willen praten over psychosociale problemen. De communicatie in de consulten met patiënten met chronische SOLK is vaak weinig gericht op het structureel uitdiepen van hun ideeën, angsten en verwachtingen. Hierdoor sluit de uitleg die de huisarts geeft vaak niet aan bij de patiënt. Dit is jammer, want goede communicatie over de aard van de klacht is essentieel voor de effectiviteit van de behandeling en begeleiding. Patiënten met chronische SOLK willen, net als andere patiënten, patiëntgerichte communicatie. Ze geven bovendien aan dat ze een langdurige en persoonlijke relatie met hun huisarts erg belangrijk vinden. Een dergelijke arts-patiëntrelatie is een krachtig therapeutisch instrument in de eerste lijn. Het belang dat zowel huisartsen als patiënten toekennen aan de communicatie en de arts-patiëntrelatie past naadloos in de filosofie van de huisartsgeneeskunde. Hoewel er ruimte is voor verbetering, is de behandeling en begeleiding van patiënten met chronische SOLK daarom een aangewezen taak voor de huisarts..

Olde Hartman TC,Van Ravesteijn H, Lucassen P. Medically unexplained physical symptoms. Huisarts Wet 2012;55(7):301-5

GENERAL

practitioners often see patients with medically unexplaïnable physïcal symptoms. Whüe only a minority (2.5%) of patients are chronïcally affected by these problems, these patients take up a relatively large proportion of GPs’ time and resources. Many GPs jïnd ït dfffïcult to treat and manage these patients, for lack of a clear and concrete explanatïon. They often resort to ’care rituals’, such as planning regular appointments. In many cases, this is because GPs have a counterproductive image of these patients as demandïng treatmentfor physïcal problems and not being prepared to consider the possibïlïty that they may have psychosocial problems. Whüe this image is undeserved, ït does ensure that GPs pay lïttle attention to the patients’ ideas, worries, and expectations. This results in a breakdown in communïcation. Thïs ïs unfortunate because patients with unexplaïnable physical problems also state that they jïnd it important to have a long-lastïng, personal relatïonshïp with theïr doctor. The doctor-patiënt relationship is one of the most powerful instruments available in primary care and there is room for improvement.

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Authors and Affiliations

  1. afdeling Eerstelijnsgeneeskunde, UMC St. Radboud, Nijmegen, 6500 HB, The Netherlands

    T. C. olde Hartman, H. van Ravesteijn &  P. Lucassen

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  1. T. C. olde Hartman
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  2. H. van Ravesteijn
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  3. P. Lucassen
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Additional information

Mogelijke belangenverstrengeling: niets aangegeven.

Beschouwing op basis van het proefschriftPersistent medically uneplained symptoms in primary care: The patient, the doctor and the consultation (Radboud Universiteit Nijmegen, 13 oktober 2011). Het volledige proefschrift is in te zien op:www.stats.uci.ru.nl/~wvgerwen/thesis_Tim_olde_Hartman.pdf. Het proefschrift werd financieel ondersteund door ZonMW (subsidienummer 920-03-339).

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Hartman, T.C.o., van Ravesteijn, H. & Lucassen, P. Onverklaarde lichamelijke klachten. HUISARTS WETENSCHAP 55, 301–305 (2012). https://doi.org/10.1007/s12445-012-0149-9

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