Primary Care Consultations About Medically Unexplained Symptoms: How Do Patients Indicate What They Want?
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Patients with medically unexplained physical symptoms (MUS) are often thought to deny psychological needs when they consult general practitioners (GPs) and to request somatic intervention instead. We tested predictions from the contrasting theory that they are transparent in communicating their psychological and other needs.
To test predictions that what patients tell GPs when they consult about MUS is related transparently to their desire for (1) emotional support, (2) symptom explanation and (3) somatic intervention.
Prospective naturalistic study. Before consultation, patients indicated what they wanted from it using a self-report questionnaire measuring patients’ desire for: emotional support, explanation and reassurance, and physical investigation and treatment. Their speech during consultation was audio-recorded, transcribed and coded utterance-by-utterance. Multilevel regression analysis tested relationships between what patients sought and what they said.
Patients (N = 326) consulting 33 GPs about symptoms that the GPs designated as MUS.
Patients who wanted emotional support spoke more about psychosocial problems, including psychosocial causes of symptoms and their need for psychosocial help. Patients who wanted explanation and reassurance suggested more physical explanations, including diseases, but did not overtly request explanation. Patients’ wish for somatic intervention was associated only with their talk about details of such interventions and not with their requests for them.
In general, patients with medically unexplained symptoms provide many cues to their desire for emotional support. They are more indirect or guarded in communicating their desire for explanation and somatic intervention.
KEY WORDSprimary care consultation medically unexplained symptoms (MUS) psychological needs
The study was supported by the UK Medical Research Council. We are grateful for the enthusiastic cooperation of the participating general practitioners. Completion of the manuscript was assisted by the award of an Institute of Advanced Study Distinguished Fellowship by LaTrobe University to PS.
PS led the design and bid for funding, data analysis and writing of the paper. CFD and GMH contributed to design and supervision of the study, data interpretation and writing. AR carried out data collection and transcript coding and contributed to design, data interpretation and writing. JCD designed and supervised data management and contributed to data analysis, interpretation and writing.
Conflict of Interest
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