How patients and family physicians communicate about persistent medically unexplained symptoms. A qualitative study of video-recorded consultations

Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor’s level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

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A qualitative study of psychodynamic and cognitive behavioural therapists’ conceptualisations of medically unexplained symptoms in their clients

Counselling and Psychotherapy Research ◽

10.1080/14733145.2010.528007 ◽

2011 ◽

Vol 11 (4) ◽

pp. 291-299 ◽

Cited By ~ 2

Author(s):

Maria Luca

Keyword(s):

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Cognitive Behavioural ◽

Medically Unexplained ◽

Unexplained Symptoms

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In their own words: qualitative study of high-utilising primary care patients with medically unexplained symptoms

BMC Family Practice ◽

10.1186/1471-2296-10-67 ◽

2009 ◽

Vol 10 (1) ◽

Cited By ~ 21

Author(s):

Francesca C Dwamena ◽

Judith S Lyles ◽

Richard M Frankel ◽

Robert C Smith

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Primary Care Patients ◽

Unexplained Symptoms

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General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study

BMC Family Practice ◽

10.1186/1471-2296-9-46 ◽

2008 ◽

Vol 9 (1) ◽

Cited By ~ 24

Author(s):

Christopher Dowrick ◽

Linda Gask ◽

John G Hughes ◽

Huw Charles-Jones ◽

Judith A Hogg ◽

...

Keyword(s):

Qualitative Study ◽

General Practitioners ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study: Table 1

BMJ Open ◽

10.1136/bmjopen-2015-009593 ◽

2015 ◽

Vol 5 (12) ◽

pp. e009593 ◽

Cited By ~ 24

Author(s):

Katherine Yon ◽

Sarah Nettleton ◽

Kate Walters ◽

Kethakie Lamahewa ◽

Marta Buszewicz

Keyword(s):

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Junior Doctors ◽

Medically Unexplained ◽

Unexplained Symptoms

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Symptom management for medically unexplained symptoms in primary care: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp19x701849 ◽

2019 ◽

Vol 69 (681) ◽

pp. e254-e261 ◽

Cited By ~ 5

Author(s):

Janna Gol ◽

Tom Terpstra ◽

Peter Lucassen ◽

Juul Houwen ◽

Sandra van Dulmen ◽

...

Keyword(s):

General Practice ◽

Qualitative Study ◽

Symptom Management ◽

Management Strategies ◽

Real Life ◽

Medically Unexplained Symptoms ◽

Daily Practice ◽

Activity Level ◽

Medically Unexplained ◽

Unexplained Symptoms

BackgroundGPs have a central position in the care of patients with medically unexplained symptoms (MUS), but GPs find their care challenging. Currently, little is known about symptom management by GPs in daily practice for patients with MUS.AimThis study aimed to describe management strategies used by GPs when confronted with patients with MUS in daily practice.Design and settingQualitative study in which videos and transcripts of 39 general practice consultations involving patients with MUS in the region of Nijmegen in the Netherlands in 2015 were analysed.MethodA thematic analysis of management strategies for MUS used by GPs in real-life consultations was performed.ResultsThe study revealed 105 management strategies in 39 consultations. Nearly half concerned symptom management; the remainder included medication, referrals, additional tests, follow-up consultations, and watchful waiting. Six themes of symptom management strategies emerged from the data: cognitions and emotions, interaction with health professionals, body focus, symptom knowledge, activity level, and external conditions. Advice on symptom management was often non-specific in terms of content, and ambiguous in terms of communication.ConclusionSymptom management is a considerable part of the care of MUS in general practice. GPs might benefit from support in how to promote symptom management to patients with MUS in specific and unambiguous terms.

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