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

Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners.

BACKGROUND: Patients with mental disorder presenting with medically unexplained symptoms (somatized mental disorder) are common in primary care, difficult to treat, and function poorly in their daily lives. AIM: To examine the effects on patient outcome and satisfaction of a training package for somatized mental disorder delivered to general practitioners (GPs). METHOD: A prospective study of a before-and-after training study of different cohorts of patients attending eight GPs who acted as their own controls. Patients were stratified according to their belief that the presenting medical symptom had either a partial or completely physical cause. RESULTS: One hundred and three patients in the cohort before training, and 112 patients in the cohort after training, were diagnosed with somatized mental disorder by the study GPs. After training there were significant improvements in interview-rated psychiatric disorder (P = 0.032) at one month, self-rated psychiatric disorder (P = 0.024), and global function (P = 0.020) at three months in patients who believed their symptoms to have a partial physical cause. Training at one-month follow-up reduced depressive symptoms in patients with major depression but did not significantly change any other outcome in patients who believed their symptoms had only a physical cause. There was no overall change in patient satisfaction. CONCLUSION: Training GPs clinically benefited patients with somatized mental disorder who believe that their symptoms have a partial physical cause