TY - JOUR
KW - Adult
KW - Attitude of Health Personnel
KW - Communication
KW - Family Practice/methods
KW - Female
KW - Focus Groups
KW - Humans
KW - Male
KW - Middle Aged
KW - Models, Psychological
KW - Patient Acceptance of Health Care/psychology
KW - Physician-Patient Relations
KW - Physicians, Family/psychology/statistics & numerical data
KW - Referral and Consultation
KW - Somatoform Disorders/diagnosis/psychology/therapy
AU - T. C. Olde Hartman
AU - L. J. Hassink-Franke
AU - P. L. Lucassen
AU - K. P. van Spaendonck
AU - C. van Weel
A1 - 
AB - 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.
BT - BMC family practice
C5 - Medically Unexplained Symptoms
CY - England
DO - 10.1186/1471-2296-10-68
JF - BMC family practice
N2 - 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.
PP - England
PY - 2009
SN - 1471-2296; 1471-2296
SP - 68
T1 - Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
T2 - BMC family practice
TI - Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
U1 - Medically Unexplained Symptoms
U2 - 19775481
U3 - 10.1186/1471-2296-10-68
VL - 10
VO - 1471-2296; 1471-2296
Y1 - 2009
ER -