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

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.

Download Full-text

Management strategies for medically unexplained symptoms in general practice: A qualitative study

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2017.03.296 ◽

2017 ◽

Vol 97 ◽

pp. 171

Author(s):

T. Terpstra ◽

J. Gol ◽

P. Lucassen ◽

J. Houwen ◽

J. Rosmalen ◽

...

Keyword(s):

General Practice ◽

Qualitative Study ◽

Management Strategies ◽

Medically Unexplained Symptoms ◽

Medically Unexplained ◽

Unexplained Symptoms

Download Full-text

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.

Download Full-text

Explanations for medically unexplained symptoms: a qualitative study on GPs in daily practice consultations

Family Practice ◽

10.1093/fampra/cmz032 ◽

2019 ◽

Author(s):

Tom Terpstra ◽

Janna M Gol ◽

Peter L B J Lucassen ◽

Juul Houwen ◽

Sandra van Dulmen ◽

...

Keyword(s):

General Practice ◽

Primary Care Practice ◽

Medically Unexplained Symptoms ◽

Daily Practice ◽

Patient Specific ◽

Care Practice ◽

Contributing Factors ◽

Making Sense ◽

Medically Unexplained ◽

Unexplained Symptoms

Abstract Background General practice is the centre of care for patients with medically unexplained symptoms (MUS). Providing explanations for MUS, i.e. making sense of symptoms, is considered to be an important part of care for MUS patients. However, little is known how general practitioners (GPs) do this in daily practice. Objective This study aimed to explore how GPs explain MUS to their patients during daily general practice consultations. Methods A thematic content analysis was performed of how GPs explained MUS to their patients based on 39 general practice consultations involving patients with MUS. Results GP provided explanations in nearly all consultations with MUS patients. Seven categories of explanation components emerged from the data: defining symptoms, stating causality, mentioning contributing factors, describing mechanisms, excluding explanations, discussing the severity of symptoms and normalizing symptoms. No pattern of how GPs constructed explanations with the various categories was observed. In general, explanations were communicated as a possibility and in a patient-specific way; however, they were not very detailed. Conclusion Although explanations for MUS are provided in most MUS consultations, there seems room for improving the explanations given in these consultations. Further studies on the effectiveness of explanations and on the interaction between patients and GP in constructing these explanations are required in order to make MUS explanations more suitable in daily primary care practice.

Download Full-text

Learning to provide patient-centered care with patients with medically unexplained symptoms: a grounded theory study in Australian general practice.

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v4i3.411 ◽

2015 ◽

Vol 4 (3) ◽

pp. 173-179

Author(s):

Louise Stone ◽

Jill Gordon

Keyword(s):

General Practice ◽

Grounded Theory ◽

Medically Unexplained Symptoms ◽

Patient Centered Care ◽

Physical Symptoms ◽

Patient Centered ◽

Grounded Theory Study ◽

Centered Care ◽

Medically Unexplained ◽

Unexplained Symptoms

Background Culture shapes the way illness is experienced and disease is understood. Patients with medically unexplained symptoms describe feeling their suffering is not valued because they lack a “legitimate” diagnosis. Doctors also describe feeling frustrated with these patients. This is particularly problematic for young general practitioners (GPs) who lack experience in managing patients with medically unexplained symptoms in primary care settings.Objectives To explore how general practice supervisors help registrars to provide patient-centered care for patients with medically unexplained. Methods A constructivist grounded theory study was undertaken with 24 general practice registrars and supervisors from Australian GP training practices in urban, rural and remote environments. Participants were asked to describe patients with mixed emotional and physical symptoms without an obvious medical diagnosis. Results Registrars came from hospital posts into general practice equipped with skills to diagnose and manage organic disease but lacked a framework for assessing and managing patients with medically unexplained symptoms. They described feelings of helplessness, frustration and sometimes hostility. Because these feelings were inconsistent with their expressed value systems, they were uncomfortable and confronting. The registrars valued interactions that helped them explore this area. Conclusions In hospital practice, biomedical language and explanations predominate, but in general practice patients bring different explanatory illness models to the consultation, using their own language, beliefs and cultural frameworks. Medically unexplained symptoms occupy a contested space in both the social and medical worlds of the doctor and patient. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from providing patient-centered care.

Download Full-text