The careful assessment tool for managing patients with medically unexplained symptoms – The experience of Slovenian family medicine trainees: A qualitative study

Abstract Introduction Primary care physicians use various tools and methods to identify medically unexplained symptoms (MUS). The main purpose of our study is to determine the views of Slovenian family medicine trainees (FMT) about using the “Careful Assessment” tool for managing patients with MUS. Methods A qualitative study using open survey questions focused on the experience of family medicine trainees in managing patients with MUS. The sample consisted of surveys from 184 family medicine trainees. These trainees analysed a total of 702 patients with MUS. Manual coding was used for quantitative content analysis. Results In the coding process, 49 codes were developed that included broader research fields about using the “Careful Assessment” tool for managing patients with MUS. The codes were grouped into four theoretically grounded, logical categories in accordance with the elaborated theoretical concept: multi-purpose utility; improved patient management; in-depth knowledge and new skills; and patient response. Conclusion The study demonstrated that, in the view of Slovenian FMT, the “Careful Assessment” tool has multi-purpose utility. The study showed that FMT felt that this tool helps them in systematic patient management. Their opinion is that it helps them establish a trusting relationship with patients, which is a precondition for providing further treatment.

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

Patient Education and Counseling ◽

10.1016/j.pec.2011.02.014 ◽

2013 ◽

Vol 90 (3) ◽

pp. 354-360 ◽

Cited By ~ 33

Author(s):

Tim C. olde Hartman ◽

Eric van Rijswijk ◽

Sandra van Dulmen ◽

Evelyn van Weel-Baumgarten ◽

Peter L.B.J. Lucassen ◽

...

Keyword(s):

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Family Physicians ◽

Medically Unexplained ◽

Unexplained Symptoms

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Challenges in the management of patients with medically unexplained symptoms in Poland: a qualitative study

Family Practice ◽

10.1093/fampra/cmr065 ◽

2011 ◽

Vol 29 (2) ◽

pp. 228-234 ◽

Cited By ~ 15

Author(s):

S. Czachowski ◽

E. Piszczek ◽

A. Sowinska ◽

T. C. olde Hartman

Keyword(s):

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

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Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study

Family Practice ◽

10.1093/fampra/19.2.178 ◽

2002 ◽

Vol 19 (2) ◽

pp. 178-182 ◽

Cited By ~ 105

Author(s):

L. Wileman

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Medically Unexplained Symptoms ◽

Primary Care Consultation ◽

Medically Unexplained ◽

Care Consultation ◽

Unexplained Symptoms

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Cognitive-behavioural therapyv.structured care for medically unexplained symptoms: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.043190 ◽

2008 ◽

Vol 193 (1) ◽

pp. 51-59 ◽

Cited By ~ 36

Author(s):

A. Sumathipala ◽

S. Siribaddana ◽

M. R. N. Abeysingha ◽

P. De Silva ◽

M. Dewey ◽

...

Keyword(s):

Primary Care ◽

Cognitive Behavioural Therapy ◽

Primary Care Physicians ◽

Medically Unexplained Symptoms ◽

Behavioural Therapy ◽

Randomised Control Trial ◽

Structured Care ◽

Cognitive Behavioural ◽

Medically Unexplained ◽

Unexplained Symptoms

BackgroundA pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficaciousAimsTo evaluate CBT provided by primary care physicians in a comparison with structured careMethodA randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 monthsResultsIn each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessmentsConclusionsCognitive–behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a ‘treatment as usual’ arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration

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How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

Journal of the Royal Society of Medicine ◽

10.1177/0141076816686348 ◽

2017 ◽

Vol 110 (2) ◽

pp. 65-72 ◽

Cited By ~ 10

Author(s):

Alex Warner ◽

Kate Walters ◽

Kethakie Lamahewa ◽

Marta Buszewicz

Keyword(s):

Qualitative Study ◽

Role Models ◽

Service Use ◽

Medical Training ◽

Management Strategies ◽

Medically Unexplained Symptoms ◽

Medical Specialty ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

And Training

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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