TY - JOUR
KW - Adaptation, Psychological
KW - Adult
KW - Attitude of Health Personnel
KW - Attitude to Health
KW - Consensus
KW - Female
KW - Humans
KW - Life Change Events
KW - Male
KW - Middle Aged
KW - Narration
KW - Outcome Assessment (Health Care)
KW - Physician-Patient Relations
KW - Physicians, Family/psychology
KW - Primary Health Care/standards/utilization
KW - Psychiatric Status Rating Scales/statistics & numerical data
KW - Qualitative Research
KW - Questionnaires
KW - Referral and Consultation
KW - Somatoform Disorders/psychology/therapy
KW - Tape Recording
AU - F. C. Dwamena
AU - J. S. Lyles
AU - R. M. Frankel
AU - R. C. Smith
A1 - 
AB - BACKGROUND: High utilising primary care patients with medically unexplained symptoms (MUS) often frustrate their primary care providers. Studies that elucidate the attitudes of these patients may help to increase understanding and improve confidence of clinicians who care for them. The objective of this study was to describe and analyze perceptions and lived experiences of high utilising primary care patients with MUS. METHODS: A purposive sample of 19 high utilising primary care patients for whom at least 50% (69.6% in this sample) of visits for two years could not be explained medically, were encouraged to talk spontaneously about themselves and answer semi-structured questions. Verbatim transcripts of interviews were analyzed using an iterative consensus building process. RESULTS: Patients with MUS almost universally described current and/or past family dysfunction and were subjected to excessive testing and ineffective empirical treatments. Three distinct groups emerged from the data. 1) Some patients, who had achieved a significant degree of psychological insight and had success in life, primarily sought explanations for their symptoms. 2) Patients who had less psychological insight were more disabled by their symptoms and felt strongly entitled to be excused from normal social obligations. Typically, these patients primarily sought symptom relief, legitimization, and support. 3) Patients who expressed worry about missed diagnoses demanded excessive care and complained when their demands were resisted. CONCLUSION: High utilising primary care patients are a heterogeneous group with similar experiences and different perceptions, behaviours and needs. Recognizing these differences may be critical to effective treatment and reduction in utilisation.
BT - BMC family practice
C5 - Medically Unexplained Symptoms
CY - England
DO - 10.1186/1471-2296-10-67
JF - BMC family practice
N2 - BACKGROUND: High utilising primary care patients with medically unexplained symptoms (MUS) often frustrate their primary care providers. Studies that elucidate the attitudes of these patients may help to increase understanding and improve confidence of clinicians who care for them. The objective of this study was to describe and analyze perceptions and lived experiences of high utilising primary care patients with MUS. METHODS: A purposive sample of 19 high utilising primary care patients for whom at least 50% (69.6% in this sample) of visits for two years could not be explained medically, were encouraged to talk spontaneously about themselves and answer semi-structured questions. Verbatim transcripts of interviews were analyzed using an iterative consensus building process. RESULTS: Patients with MUS almost universally described current and/or past family dysfunction and were subjected to excessive testing and ineffective empirical treatments. Three distinct groups emerged from the data. 1) Some patients, who had achieved a significant degree of psychological insight and had success in life, primarily sought explanations for their symptoms. 2) Patients who had less psychological insight were more disabled by their symptoms and felt strongly entitled to be excused from normal social obligations. Typically, these patients primarily sought symptom relief, legitimization, and support. 3) Patients who expressed worry about missed diagnoses demanded excessive care and complained when their demands were resisted. CONCLUSION: High utilising primary care patients are a heterogeneous group with similar experiences and different perceptions, behaviours and needs. Recognizing these differences may be critical to effective treatment and reduction in utilisation.
PP - England
PY - 2009
SN - 1471-2296; 1471-2296
SP - 67
T1 - In their own words: qualitative study of high-utilising primary care patients with medically unexplained symptoms
T2 - BMC family practice
TI - In their own words: qualitative study of high-utilising primary care patients with medically unexplained symptoms
U1 - Medically Unexplained Symptoms
U2 - 19772582
U3 - 10.1186/1471-2296-10-67
VL - 10
VO - 1471-2296; 1471-2296
Y1 - 2009
ER -