What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

  • Sarah Peters
  • Anne Rogers
  • Peter Salmon
  • Linda Gask
  • Chris Dowrick
  • Maria Towey
  • Rebecca Clifford
  • Richard Morriss
Original Article

Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Qualitative study.

PARTICIPANTS

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.

APPROACH

Thematic analysis of in-depth interviews.

RESULTS

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.

CONCLUSIONS

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 WORDS

doctor–patient communication medically unexplained symptoms reattribution 

Notes

Acknowledgments

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

None disclosed.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Sarah Peters
    • 1
  • Anne Rogers
    • 2
  • Peter Salmon
    • 3
  • Linda Gask
    • 2
  • Chris Dowrick
    • 3
  • Maria Towey
    • 2
  • Rebecca Clifford
    • 3
  • Richard Morriss
    • 4
  1. 1.School of Psychological SciencesUniversity of ManchesterManchesterUK
  2. 2.National Primary Care Research and Development CentreUniversity of ManchesterManchesterUK
  3. 3.School of Population, Community and Behavioural ScienceUniversity of LiverpoolLiverpoolUK
  4. 4.School of Community Health SciencesUniversity of NottinghamNottinghamUK

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