Improving GP communication in consultations on medically unexplained symptoms: a qualitative interview study with patients in primary care

BackgroundMany GPs find the care of patients with medically unexplained symptoms (MUS) challenging. Patients themselves are often not satisfied with the care they receive.AimTo explore the problems patients with MUS experience in communication during consultations, with the aim of improving such consultationsDesign and settingA qualitative analysis of semi-structured interviews.MethodGP consultations were videorecorded and the GPs were asked immediately afterwards whether MUS were presented. Patients in these MUS consultations were asked to reflect on the consultation in a semi-structured interview while watching a recording of their own consultation.ResultsOf the 393 videorecorded consultations, 43 contained MUS. Patients who did identified six categories of problems. First, they reported a mismatch between the GP’s and their own agenda. Second, patients indicated that the GP evoked an uncomfortable feeling in them during the consultation. Third, they found that GPs did not provide a specific management plan for their symptoms. Fourth, patients indicated that the GP was not well prepared for the consultation. Fifth, they perceived prejudices in the GP during the consultation. Finally, one patient found that the GP did not acknowledge a limited understanding of the origin of the symptoms.ConclusionAccording to patients, GPs can improve their consultations on MUS by making genuine contact with their patients, by paying more attention to the patient’s agenda, and by avoiding evoking uncomfortable feelings and displaying prejudices. They should prepare their consultations and focus on the issues that matter to patients, for example, symptom management. GPs should be honest to patients when they do not understand the origin of symptoms.

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Gestures in patients’ presentation of medically unexplained symptoms (MUS)

Gesture ◽

10.1075/gest.17011.sow ◽

2021 ◽

Vol 19 (1) ◽

pp. 97-127

Author(s):

Agnieszka Sowińska ◽

Monika Boruta-Żywiczyńska

Keyword(s):

Medically Unexplained Symptoms ◽

High Rate ◽

Medical Professionals ◽

Symptom Presentation ◽

Structured Interviews ◽

Symptom Rate ◽

Patient’S Experience ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

Low Rate

Abstract The aim of this paper is to explore speech-accompanying gesture use in presentation of medically unexplained symptoms (MUS). The data are 19 video-filmed semi-structured interviews with patients presenting MUS. Four patterns of gestural behaviors are established in symptom presentation: (1) No gesturing; (2) Overall low gesture rate; (3) Overall high gesture rate with low rate for symptoms; (4) Overall high gesture rate with high rate for symptoms. The patients with overall low gesture rate tend to perform deictic gestures, pointing to exact locations of the symptoms; those with overall high gesture rate and low symptom rate produce metaphorics, and those who gesticulate at high rates – mainly iconics and metaphorics. Although exact factors that lead to the four types of gesturing patterns are unclear, the findings encourage medical professionals to attend to the information in gesture use in order to obtain a better understanding of the patient’s experience of MUS.

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Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study

BMC Family Practice ◽

10.1186/s12875-019-1049-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Juul Houwen ◽

Peter L. B. J. Lucassen ◽

Anna Verwiel ◽

Hugo W. Stappers ◽

Willem J. J. Assendelft ◽

...

Keyword(s):

Comparative Analysis ◽

Medically Unexplained Symptoms ◽

Structured Interview ◽

Good Communication ◽

Physician Patient Communication ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

Constant Comparative Analysis ◽

Physician Patient

Abstract Background Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs’ difficulties in communication during MUS consultations. Methods We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication. Results Twenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs’ communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient’s story, the quality of the contact and sharing decisions). Analysis of the patients’ views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n = 42) the patients’ comments were positive. The video-recorded transcripts (n = 9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient). Conclusion GPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient).

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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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A Qualitative Study of the Views of Patients With Medically Unexplained Symptoms on The BodyMind Approach®: Employing Embodied Methods and Arts Practices for Self-Management

Frontiers in Psychology ◽

10.3389/fpsyg.2020.554566 ◽

2020 ◽

Vol 11 ◽

Author(s):

Helen Payne ◽

Susan Deanie Margaret Brooks

Keyword(s):

Meaning Making ◽

Medically Unexplained Symptoms ◽

The Body ◽

Self Management ◽

Structured Interviews ◽

Post Intervention ◽

The Arts ◽

Medically Unexplained ◽

Unexplained Symptoms ◽

Mind Set

The arts provide openings for symbolic expression by engaging the sensory experience in the body they become a source of insight through embodied cognition and emotion, enabling meaning-making, and acting as a catalyst for change. This synthesis of sensation and enactive, embodied expression through movement and the arts is capitalized on in The BodyMind Approach® (TBMA). It is integral to this biopsychosocial, innovative, unique intervention for people suffering medically unexplained symptoms (MUS) applied in primary healthcare. The relevance of embodiment and arts practices in TBMA are discussed in relation to the views of participants in the pursuit of self-management. If widely employed TBMA could have an enormous impact, reach, and significance for patients and global health services. This original pre-clinical trial of qualitative research reports on the perceptions of participant patients with generic MUS, a world-wide issue usually treated by either psychological therapy or physiotherapy. TBMA is not a therapy but a health education program founded upon the concept of an integration of psychological elements with physiological, bodily, and sensory experiences. Thematic analysis of qualitative data sets from open-ended questions in semi-structured interviews and a written questionnaire post intervention is presented. Five aspects which appear to be key to learning self-management were derived from analyzing the data: (1) body with mind connections; (2) importance of facilitation; (3) potential benefits; (4) preparedness for change; (5) self-acceptance/compassion. This article advances the discourse on the nature of self-management for MUS through changing the mind-set and the relationship participants have with their bodily symptom/s through employing embodied methods and arts practices, challenging current, and solely verbal, psychological conceptual frameworks. Rigor lies in the method of data analysis using cross verification of credibility between reported findings and scrutiny by stakeholders. We conclude that facilitated TBMA groups employing embodied methods and arts practices can act as a method for developing the self-management of MUS and improving wellbeing.

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GPs’ decisions about prescribing end-of-life anticipatory medications: a qualitative study

British Journal of General Practice ◽

10.3399/bjgp20x712625 ◽

2020 ◽

Vol 70 (699) ◽

pp. e731-e739 ◽

Cited By ~ 2

Author(s):

Ben Bowers ◽

Sam S Barclay ◽

Kristian Pollock ◽

Stephen Barclay

Keyword(s):

Decision Making ◽

End Of Life ◽

Thematic Analysis ◽

Symptom Management ◽

Qualitative Interview ◽

Structured Interviews ◽

Clinical Recommendation ◽

Qualitative Interview Study ◽

Decision Making Processes ◽

Purposive Sample

BackgroundGPs have a central role in decisions about prescribing anticipatory medications to help control symptoms at the end of life. Little is known about GPs’ decision-making processes in prescribing anticipatory medications, how they discuss this with patients and families, or the subsequent use of prescribed drugs.AimTo explore GPs’ decision-making processes in the prescribing and use of anticipatory medications for patients at the end of life.Design and settingA qualitative interview study with GPs working in one English county.MethodSemi-structured interviews were conducted with a purposive sample of 13 GPs. Interview transcripts were analysed inductively using thematic analysis.ResultsThree themes were constructed from the data: something we can do, getting the timing right, and delegating care while retaining responsibility. Anticipatory medications were a tangible intervention GPs felt they could offer patients approaching death (something we can do). The prescribing of anticipatory medications was recognised as a harbinger of death for patients and their families. Nevertheless, GPs preferred to discuss and prescribe anticipatory medications weeks before death was expected whenever possible (getting the timing right). After prescribing medications, GPs relied on nurses to assess when to administer drugs and keep them updated about their use (delegating care while retaining responsibility).ConclusionGPs view anticipatory medications as key to symptom management for patients at the end of life. The drugs are often presented as a clinical recommendation to ensure patients and families accept the prescription. GPs need regular access to nurses and rely on their skills to administer drugs appropriately. Patients’ and families’ experiences of anticipatory medications, and their preferences for involvement in decision making, warrant urgent investigation.

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