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

<p>Abstract</p> <p>Background</p> <p>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,...

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Main Authors: van Spaendonck Karel P, Lucassen Peter L, Hassink-Franke Lieke J, olde Hartman Tim C, van Weel Chris
Format: Article
Language:English
Published: BMC 2009-09-01
Series:BMC Family Practice
Online Access:http://www.biomedcentral.com/1471-2296/10/68
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author van Spaendonck Karel P
Lucassen Peter L
Hassink-Franke Lieke J
olde Hartman Tim C
van Weel Chris
author_facet van Spaendonck Karel P
Lucassen Peter L
Hassink-Franke Lieke J
olde Hartman Tim C
van Weel Chris
author_sort van Spaendonck Karel P
collection DOAJ
description <p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p>
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spelling doaj.art-040b7d2e8bdc4a4e8d0a47ba367784672022-12-22T03:38:02ZengBMCBMC Family Practice1471-22962009-09-011016810.1186/1471-2296-10-68Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group studyvan Spaendonck Karel PLucassen Peter LHassink-Franke Lieke Jolde Hartman Tim Cvan Weel Chris<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p>http://www.biomedcentral.com/1471-2296/10/68
spellingShingle van Spaendonck Karel P
Lucassen Peter L
Hassink-Franke Lieke J
olde Hartman Tim C
van Weel Chris
Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
BMC Family Practice
title Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
title_full Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
title_fullStr Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
title_full_unstemmed Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
title_short Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
title_sort explanation and relations how do general practitioners deal with patients with persistent medically unexplained symptoms a focus group study
url http://www.biomedcentral.com/1471-2296/10/68
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