Primary Care Consultations About Medically Unexplained Symptoms: How Do Patients Indicate What They Want?

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2009 Jan 24

PMID 19165548

Citations 18

Authors

Peter Salmon

Adele Ring

Gerry M Humphris

John C Davies

Christopher F Dowrick

Affiliations

Soon will be listed here.

Abstract

Background: Patients with medically unexplained physical symptoms (MUS) are often thought to deny psychological needs when they consult general practitioners (GPs) and to request somatic intervention instead. We tested predictions from the contrasting theory that they are transparent in communicating their psychological and other needs.

Objective: To test predictions that what patients tell GPs when they consult about MUS is related transparently to their desire for (1) emotional support, (2) symptom explanation and (3) somatic intervention.

Design: Prospective naturalistic study. Before consultation, patients indicated what they wanted from it using a self-report questionnaire measuring patients' desire for: emotional support, explanation and reassurance, and physical investigation and treatment. Their speech during consultation was audio-recorded, transcribed and coded utterance-by-utterance. Multilevel regression analysis tested relationships between what patients sought and what they said.

Participants: Patients (N = 326) consulting 33 GPs about symptoms that the GPs designated as MUS.

Results: Patients who wanted emotional support spoke more about psychosocial problems, including psychosocial causes of symptoms and their need for psychosocial help. Patients who wanted explanation and reassurance suggested more physical explanations, including diseases, but did not overtly request explanation. Patients' wish for somatic intervention was associated only with their talk about details of such interventions and not with their requests for them.

Conclusions: In general, patients with medically unexplained symptoms provide many cues to their desire for emotional support. They are more indirect or guarded in communicating their desire for explanation and somatic intervention.

Citing Articles

Treatment and life goals among veterans with Gulf War illness.

Sullivan N, Schorpp H, Crosky S, Thien S, Helmer D, Litke D PLoS One. 2023; 18(11):e0295168.

PMID: 38033143 PMC: 10688846. DOI: 10.1371/journal.pone.0295168.

Utility and optimal cut-off point of the Somatic Symptom Scale-8 for central sensitization syndrome among outpatients with somatic symptoms and related disorders.

Hashimoto K, Takeuchi T, Hiiragi M, Koyama A, Nakamura Y, Hashizume M Biopsychosoc Med. 2022; 16(1):24.

PMID: 36434700 PMC: 9694559. DOI: 10.1186/s13030-022-00253-2.

Communication interventions for medically unexplained symptom conditions in general practice: A systematic review and meta-analysis of randomised controlled trials.

Byrne A, Scantlebury A, Jones K, Doherty L, Torgerson D PLoS One. 2022; 17(11):e0277538.

PMID: 36374916 PMC: 9662736. DOI: 10.1371/journal.pone.0277538.

Communicating With Parents and Preschool Children: A Qualitative Exploration of Dental Professional-Parent-Child Interactions During Paediatric Dental Consultations to Prevent Early Childhood Caries.

Yuan S, Humphris G, Macpherson L, Ross A, Freeman R Front Public Health. 2021; 9:669395.

PMID: 34055728 PMC: 8149946. DOI: 10.3389/fpubh.2021.669395.

Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation.

Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A Health Technol Assess. 2020; 24(46):1-490.

PMID: 32975190 PMC: 7548871. DOI: 10.3310/hta24460.

References

Garcia-Campayo J, Sanz-Carrillo C, Monton C . Management of somatisers in primary care: are family doctors motivated?. Aust N Z J Psychiatry. 1998; 32(4):528-33. DOI: 10.3109/00048679809068327. View

Valori R, Woloshynowych M, Bellenger N, Aluvihare V, Salmon P . The Patient Requests Form: a way of measuring what patients want from their general practitioner. J Psychosom Res. 1996; 40(1):87-94. DOI: 10.1016/0022-3999(95)00548-x. View

Salmon P, Dowrick C, Ring A, Humphris G . Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners. Br J Gen Pract. 2004; 54(500):171-6. PMC: 1314826. View

Lamberg L . New mind/body tactics target medically unexplained physical symptoms and fears. JAMA. 2005; 294(17):2152-4. DOI: 10.1001/jama.294.17.2152. View

Leiknes K, Finset A, Moum T, Sandanger I . Methodological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study. J Psychosom Res. 2006; 61(2):169-79. DOI: 10.1016/j.jpsychores.2006.01.007. View

Barsky A, Ettner S, Horsky J, Bates D . Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care. 2001; 39(7):705-15. DOI: 10.1097/00005650-200107000-00007. View

Morriss R, Gask L . Treatment of patients with somatized mental disorder: effects of reattribution training on outcomes under the direct control of the family doctor. Psychosomatics. 2002; 43(5):394-9. DOI: 10.1176/appi.psy.43.5.394. View

Salmon P, Peters S, Clifford R, Iredale W, Gask L, Rogers A . Why do general practitioners decline training to improve management of medically unexplained symptoms?. J Gen Intern Med. 2007; 22(5):565-71. PMC: 1855690. DOI: 10.1007/s11606-006-0094-z. View

Smith Jr G, Monson R, Ray D . Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization. Arch Intern Med. 1986; 146(1):69-72. View

10.

Good M, Good B, Nassi A . Patient requests in primary health care settings: development and validation of a research instrument. J Behav Med. 1983; 6(2):151-68. DOI: 10.1007/BF00845378. View

11.

Kirmayer L, Robbins J . Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychol Med. 1996; 26(5):937-51. DOI: 10.1017/s0033291700035273. View

12.

Barsky A, Orav E, Bates D . Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005; 62(8):903-10. DOI: 10.1001/archpsyc.62.8.903. View

13.

Kroenke K, Mangelsdorff A . Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989; 86(3):262-6. DOI: 10.1016/0002-9343(89)90293-3. View

14.

van der Weijden T, van Velsen M, Dinant G, van Hasselt C, Grol R . Unexplained complaints in general practice: prevalence, patients' expectations, and professionals' test-ordering behavior. Med Decis Making. 2003; 23(3):226-31. DOI: 10.1177/0272989X03023003004. View

15.

Stanley I, Peters S, Salmon P . A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms. Int J Psychiatry Med. 2002; 32(2):125-40. DOI: 10.2190/AVM3-8GU8-JW70-5RX5. View

16.

Hartz A, Noyes R, Bentler S, Damiano P, Willard J, Momany E . Unexplained symptoms in primary care: perspectives of doctors and patients. Gen Hosp Psychiatry. 2000; 22(3):144-52. DOI: 10.1016/s0163-8343(00)00060-8. View

17.

Dowrick C, Ring A, Humphris G, Salmon P . Normalisation of unexplained symptoms by general practitioners: a functional typology. Br J Gen Pract. 2004; 54(500):165-70. PMC: 1314825. View

18.

Peveler R, Kilkenny L, Kinmonth A . Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997; 42(3):245-52. DOI: 10.1016/s0022-3999(96)00292-9. View

19.

Kirmayer L, Robbins J . Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis. 1991; 179(11):647-55. DOI: 10.1097/00005053-199111000-00001. View

20.

Arnold I, Speckens A, van Hemert A . Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care. J Psychosom Res. 2004; 57(6):517-20. DOI: 10.1016/j.jpsychores.2004.04.369. View