How to learn skilled communication in primary care MUS consultations: a focus group study

Hugo W. Stappers,Tim C. olde Hartman,Sandra van Dulmen,Juul Houwen,Peter L. B. J. Lucassen,Aniek van Duijnhoven,Karel van Spaendonck

doi:10.1080/02813432.2021.1882088

Abstract

Background Many general practitioners (GPs) experience communication problems in medically unexplained symptoms (MUS) consultations as they are insufficiently equipped with adequate communication skills or do not apply these in MUS consultations. Objective To define the most important learnable communication elements during MUS consultations according to MUS patients, GPs, MUS experts and teachers and to explore how these elements should be taught to GPs and GP trainees. Methods Five focus groups were conducted with homogeneous groups of MUS patients, GPs, MUS experts and teachers. MUS patients and GPs formulated a list of important communication elements. MUS experts identified from this list the most important communication elements. Teachers explored how these elements could be trained to GPs and GP trainees. Two researchers independently analysed the data applying the principles of constant comparative analysis. Results MUS patients and GPs identified a list of important communication elements. From this list, MUS experts selected five important communication elements: (1) thorough somatic and psychosocial exploration, (2) communication with empathy, (3) creating a shared understanding of the problem, (4) providing a tangible explanation and (5) taking control. Teachers described three teaching methods for these communication elements: (1) awareness and reflection of GPs about their feelings towards MUS patients, (2) assessment of GPs’ individual needs and (3) training and supervision in daily practice. Conclusion Teachers consider a focus on personal attitudes and needs, which should be guided by opportunities to practice and receive supervision, as the best method to teach GPs about communication in MUS consultations. KEY POINTS Many GPs experience difficulties in communication with patients with MUS. There is a need to equip GPs with communication skills to manage MUS consultations more adequately. Role-playing with simulation patients, reflection on video-consultations and joint consultations with the supervisor may increase the GPs’ awareness of their attitude towards MUS patients and may help GPs to identify their individual learning-points.

Highlights

Unexplained symptoms (MUS) are common in primary care: in about 3–11% of the presented symptoms, the general practitioner (GP) cannot attribute the symptoms to an underlying disease [1]
To build further on these findings, we studied which communication elements medically unexplained symptoms (MUS) patients, GPs and MUS experts consider important and which of these elements can be learned to GPs in order to improve GPs’ communication
In the first and second focus group with respectively GPs and MUS patients, we explored which communication elements the participants considered relevant for MUS consultations

Summary

Introduction

Unexplained symptoms (MUS) are common in primary care: in about 3–11% of the presented symptoms, the general practitioner (GP) cannot attribute the symptoms to an underlying disease [1]. Many general practitioners (GPs) experience communication problems in medically unexplained symptoms (MUS) consultations as they are insufficiently equipped with adequate communication skills or do not apply these in MUS consultations. MUS experts identified from this list the most important communication elements Teachers explored how these elements could be trained to GPs and GP trainees. Results: MUS patients and GPs identified a list of important communication elements From this list, MUS experts selected five important communication elements: (1) thorough somatic and psychosocial exploration, (2) communication with empathy, (3) creating a shared understanding of the problem, (4) providing a tangible explanation and (5) taking control. The mean working experience of the five general practitioners of the first focus group was 25.5 (range 2.5–35) years. The third focus group consisted of 3 general practitioners and 2 psychiatrists

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Conclusion