Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

Contains fulltext : 80758.pdf (publisher's version ) (Open Access)BACKGROUND: Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. METHODS: A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. RESULTS: GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. CONCLUSION: GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions

Online monitoring of aluminium primary production gas composition by use of Fourier-transform infrared spectroscopy

Online monitoring of aluminium primary production raw gas is challenging due to the high concentration of HF in the presence of water. Tunable Diode Laser (TDL) analyzers retrofitted with sapphire optical windows allow for online monitoring of raw gas composistion. These systems are however limited to one or two gas constituents. In order to make use of multi-component analyzers like Fourier-Transform InfraRed Spectrometers (FTIR), HF must be selectively removed by filtration. This work presents some results from complete mapping of raw gas composition by comparing results from HF filtrated as well as non-filtrated measurements. The multivariate calibration models established for mapping of the raw gas is discussed. Open-path FTIR spectroscopy was applied in order to quantify fugitive emissions of HF and SO2. Quantitation showed good correlation with reported emissions. Monitoring of fugitive PFC emissions was also evaluated.acceptedVersio