Abstract
BackgroundPhysicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms (MUS). In order to solve their patients' problems and out of a fear of overlooking a serious disease, many physicians give their patients full physical examinations and interventions, thereby incorrectly confirming the somatic nature of their condition. Preventing somatization could be achieved by examining the patient's symptom presentation for clues to underlying psychosocial issues and by an appropriate physician response.MethodsNinety-seven videotaped medical visits from primary care patients presenting MUS for the first time were analyzed. Patients' presentations were categorized in: (1) symptoms only; (2) symptoms with a clue to an underlying concern; or (3) symptoms with an explicit concern. General practitioners' (GPs') responses to patients' presentation were classified into ignoring or more or less exploring responses. Exploring responses were further subdivided in non-directional explorations, clue explorations and medical explorations.ResultsResults show that most patients presented their symptoms together with a reference to an underlying concern. Yet, most of them did so in an implicit way. GPs usually explored the concern presented by the patients, but most often in a medical way only.ConclusionTo address the potential psychological basis of patients' medically unexplained symptoms, GPs should pay more attention to the specific clues patients present to them. Likewise, in order to receive full attention, patients should try to present their concerns more explicitly.
Highlights
Physicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms (MUS)
The major issue in these medically unexplained symptoms (MUS) is that there is a delicate balance between diagnosing MUS and the physician missing a somatic disease
Participants In order to analyse the initial communication between patients and physicians about the physical symptoms as a presentation of MUS, video recordings of consultations in the general practitioners (GPs)'s office were obtained from The Second Dutch National Survey of General Practice (DNSGP2) performed by NIVEL in 2001 [8]
Summary
Physicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms (MUS). In primary as well as secondary care a large number of patients commonly present with persistent physical symptoms for which no somatic origin can be found. Because physicians take responsibility for solving their patients' problems and because they are afraid of overlooking serious diseases, many patients receive a whole spectrum of physical examinations, interventions and referrals, to exclude potential somatic causes. This contributes to their beliefs that the presented symptoms are of physical origin, which was described by Quill [1] and others as a pathologic intervention cycle, suggesting the chronic nature of these symptoms to be of iatrogenic origin. Lang et al [4] reviewed the different kinds of clues expressed by patients, referring to their own explanations and concerns about their illnesses
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