Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study

Anna Verwiel,Hugo W. Stappers,Willem J. J. Assendelft,Sandra van Dulmen,Tim C. olde Hartman,Juul Houwen,Peter L. B. J. Lucassen

doi:10.1186/s12875-019-1049-x

Abstract

BackgroundMany general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs’ difficulties in communication during MUS consultations.MethodsWe video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication.ResultsTwenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs’ communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient’s story, the quality of the contact and sharing decisions). Analysis of the patients’ views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n = 42) the patients’ comments were positive. The video-recorded transcripts (n = 9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient).ConclusionGPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient).

Highlights

Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS)
Based on the data from questionnaires, we studied what patients expected from their GP regarding communication, what they experienced during the consultation and the extent to which GPs met patients’ expectation
Of the 16 GPs who did not participate, four were women, six practices were located in rural areas and the other 10 were located in the city

Summary

Introduction

Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). Unexplained symptoms (MUS) are common in general practice. MUS are physical symptoms for which no pathological cause can be found after a proper examination. Patients with severe MUS suffer from their symptoms, are functionally impaired, and are at risk of potentially harmful additional testing and treatment procedures [4]. General practitioners (GPs) have a central role in managing patients with MUS. GPs consider themselves as adequately positioned to manage these patients [5]. This is in line with MUS patients’ views, as they feel the need for continuity of care, one of the core values of primary care [6]. Many GPs find MUS consultations challenging and experience problems in these consultations [7,8,9,10]

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Discussion

Conclusion