What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms
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Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor–patient communication, though not necessarily patient health.
To examine patient experiences of GPs’ attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.
Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general.
Thematic analysis of in-depth interviews.
Potential barriers include the complexity of patients’ problems and patients’ judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.
Improving GP explanation of unexplained symptoms is insufficient to reduce patients’ concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor–patient relationship in which patients can perceive psychosocial enquiry as appropriate.
KEY WORDSdoctor–patient communication medically unexplained symptoms reattribution
Funding for the project came from the UK Medical Research Council (grant reference no. G0100809, ISRCTN 44384258), Mersey Care NHS Trust and Mersey Primary Care Research Organisation. We are grateful for the cooperation of the participating patients and physicians and collaboration of Professor Francis Creed, Professor Graham Dunn, Dr Huw Charles Jones and Dr Barry Lewis in the design of the MUST trial, and to Judith Hogg for managing the trial.
Conflict of interest
- 5.Morriss R, Dowrick C, Salmon P, et al. Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (MUST). Gen Hosp Psychiatry. 2006;28:343–51.PubMedCrossRefGoogle Scholar
- 6.Morriss R, Gask L, Dowrick C, Salmon P, Peters S. Primary care: management of persistent medically unexplained symptoms. In: Lloyd GG, Guthrie E, eds. Handbook of Liaison Psychiatry. Cambridge: Cambridge University Press; 2007.Google Scholar
- 9.Blankenstein AH. Somatising patients in general practice reattribution, a promising approach. PhD thesis. Netherlands: Vrije Universiteit; 2001.Google Scholar
- 19.Medical Research Council. A frame work for development and evaluation of RCTs for complex interventions to improve health. London: MRC; 2000.Google Scholar
- 20.Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2Thousand Oaks, CA: Sage; 1998.Google Scholar
- 27.Thom DH, Campbell B. Patient–physician trust: an exploratory study. J Family Pract. 1997;44(2):169–76.Google Scholar
- 30.Dirkzwager AJE, Verhaak PFM. Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Fam Pract. 2007;33(8).Google Scholar