OBJECTIVES: To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurised to deliver somatic interventions. DESIGN: Qualitative analysis of audiorecorded consultations between patients and general practitioners. SETTING: 7 general practices in Merseyside, England. PARTICIPANTS: 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained. MAIN OUTCOME MEASURES: Inductive qualitative analysis of ways in which patients presented their symptoms to general practitioners. RESULTS: Although 34 patients received somatic interventions (27 received drug prescriptions, 12 underwent investigations, and four were referred), only 10 requested them. However, patients presented in other ways that had the potential to pressurise general practitioners, including: graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations. CONCLUSIONS: Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically.
OBJECTIVES: To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurised to deliver somatic interventions. DESIGN: Qualitative analysis of audiorecorded consultations between patients and general practitioners. SETTING: 7 general practices in Merseyside, England. PARTICIPANTS: 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained. MAIN OUTCOME MEASURES: Inductive qualitative analysis of ways in which patients presented their symptoms to general practitioners. RESULTS: Although 34 patients received somatic interventions (27 received drug prescriptions, 12 underwent investigations, and four were referred), only 10 requested them. However, patients presented in other ways that had the potential to pressurise general practitioners, including: graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations. CONCLUSIONS: Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically.
Authors: Tim C olde Hartman; Hiske van Ravesteijn; Peter Lucassen; Kees van Boven; Evelyn van Weel-Baumgarten; Chris van Weel Journal: Br J Gen Pract Date: 2011-12 Impact factor: 5.386
Authors: Charlotte Paterson; Rod S Taylor; Peter Griffiths; Nicky Britten; Sue Rugg; Jackie Bridges; Bruce McCallum; Gerad Kite Journal: Br J Gen Pract Date: 2011-06 Impact factor: 5.386
Authors: Janna Gol; Tom Terpstra; Peter Lucassen; Juul Houwen; Sandra van Dulmen; Tim C Olde Hartman; Judith Rosmalen Journal: Br J Gen Pract Date: 2019-03-11 Impact factor: 5.386
Authors: Tim C Olde Hartman; Lieke J Hassink-Franke; Peter L Lucassen; Karel P van Spaendonck; Chris van Weel Journal: BMC Fam Pract Date: 2009-09-24 Impact factor: 2.497