Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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The degree of impairment in both BDS groups was remarkably higher than previously found for chronic physical conditions such as arthritis, chronic lung disease, diabetes, and chronic heart disease in the general population.
“The degree of impairment in both BDS groups was remarkably higher than previously found for chronic physical conditions such as arthritis, chronic lung disease, diabetes, and chronic heart disease in the general population (27).”
From Long-term outcome of bodily distress syndrome in primary care: a follow-up study on health care costs, work disability, and self-rated health (2017) · cites this paper as [27]
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Cites
The Discovery of Grounded Theory: Strategies for Qualitative Research
Glaser, B. G., & Strauss, A. L. (2017) · Aldine (Routledge reprint) · doi:10.4324/9780203793206 · Cited by 25,789 · see citing works
Qualitative research. Introducing focus groups.
Kitzinger, J. (1995) · BMJ · doi:10.1136/bmj.311.7000.299 · Cited by 6,939 · see citing works
Qualitative Research: Rigour and qualitative research
Mays, N., & Pope, C. (1995) · BMJ · doi:10.1136/bmj.311.6997.109 · Cited by 2,715 · see citing works
Qualitative Research: Qualitative interviews in medical research
Britten, N. (1995) · BMJ · doi:10.1136/bmj.311.6999.251 · Cited by 1,670 · see citing works
The Doctor, His Patient, and the Illness
BALINT, M. (1957) · Postgraduate Medical Journal · doi:10.1136/pgmj.33.382.417-a · Cited by 1,270 · see citing works
THE DOCTOR, HIS PATIENT, AND THE ILLNESS
Bálint, M. (1955) · The Lancet · doi:10.1016/s0140-6736(55)91061-8 · Cited by 799 · see citing works
(1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-2-173_1 · Cited by 796 · see citing works
Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., Ferrier, K., & Payne, S. (2001) · BMJ · doi:10.1136/bmj.322.7284.468 · Cited by 766 · see citing works
Management of functional somatic syndromes
Henningsen, P., Zipfel, S., & Herzog, W. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60159-7 · Cited by 741 · see citing works
Levenstein, J. H., McCracken, E. C., McWhinney, I. R., Stewart, M., & Brown, J. B. (1986) · Family Practice · doi:10.1093/fampra/3.1.24 · Cited by 525 · see citing works
Explaining medically unexplained symptoms-models and mechanisms
Rief, W., & Broadbent, E. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.07.005 · Cited by 412 · see citing works
Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis
Salmon, P., Peters, S., & Stanley, I. M. (1999) · BMJ · doi:10.1136/bmj.318.7180.372 · Cited by 366 · see citing works
Somatic presentations of psychiatric illness in primary care setting
Goldberg, D. P., & Bridges, K. (1988) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(88)90048-7 · Cited by 313 · see citing works
Somatization and Medicalization in the Era of Managed Care
BARSKY, A. J. (1995) · JAMA · doi:10.1001/jama.1995.03530240041038 · Cited by 290 · see citing works
The difficult doctor-patient relationship: somatization, personality and psychopathology.
Hahn, S., Thompson, K., Wills, T., Stern, V., & Budner, N. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90212-7 · Cited by 276 · see citing works
Somatization and medicalization in the era of managed care
BARSKY, A. J. (1995) · JAMA · doi:10.1001/jama.274.24.1931 · Cited by 275 · see citing works
Qualitative research methods in general practice and primary care
Britten, N., Jones, R. H., Murphy, E., & Stacy, R. (1995) · Family Practice · doi:10.1093/fampra/12.1.104 · Cited by 272 · see citing works
Hartman, O. (2009) · doi:10.1016/j.jpsychores.2008.09.018 · Cited by 261 · see citing works
Self-citationPersistent presentation of medically unexplained symptoms in general practice
Verhaak, P. F. M. (2006) · Family Practice · doi:10.1093/fampra/cml016 · Cited by 211 · see citing works
Lin, E. H. B., Katon, W. J., Korff, M. V., Bush, T. M., Lipscomb, P. A., Russo, J. E., & Wagner, E. H. (1991) · Journal of General Internal Medicine · doi:10.1007/bf02598969 · Cited by 209 · see citing works
Åsbring, P., & Närvänen, A.-L. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00420-3 · Cited by 207 · see citing works
Salmon, P., Dowrick, C. F., Ring, A., & Humphris, G. M. (2004) · Europe PMC (PubMed Central) · Cited by 198 · see citing works
The doctor/patient relationship and its effect upon outcome.
Stewart, M., McWhinney, I. R., & Buck, C. W. (1979) · PubMed · Cited by 196 · see citing works
Peters, S., Stanley, I. M., Rose, M., & Salmon, P. (1998) · Social Science & Medicine · doi:10.1016/s0277-9536(97)00200-1 · Cited by 196 · see citing works
Functional somatic symptoms and syndromes
Mayou, R., & Farmer, A. (2002) · BMJ · doi:10.1136/bmj.325.7358.265 · Cited by 178 · see citing works
Normalisation of unexplained symptoms by general practitioners: a functional typology.
Dowrick, C. F., Ring, A., Humphris, G. M., & Salmon, P. (2004) · Europe PMC (PubMed Central) · Cited by 173 · see citing works
Salmon, P., Ring, A., Dowrick, C. F., & Humphris, G. M. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.03.004 · Cited by 172 · see citing works
Ring, A., Dowrick, C. F., Humphris, G. M., & Salmon, P. (2004) · BMJ · doi:10.1136/bmj.38057.622639.ee · Cited by 167 · see citing works
Salmon, P. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.03.008 · Cited by 163 · see citing works
Reflections on the doctor-patient relationship: from evidence and experience.
Stewart, M. (2005) · PubMed · Cited by 154 · see citing works
Medically unexplained symptoms--GPs' attitudes towards their cause and management
Reid, S., Whooley, D., Crayford, T. J. B., & Hotopf, M. H. (2001) · Family Practice · doi:10.1093/fampra/18.5.519 · Cited by 150 · see citing works
Management of medically unexplained symptoms
Rosendal, M., Olesen, F., & Fink, P. (2004) · BMJ · doi:10.1136/bmj.330.7481.4 · Cited by 145 · see citing works
Physicians’ Responses to Patients’ Medically Unexplained Symptoms
Epstein, R. M., Shields, C. G., Meldrum, S. C., Fiscella, K., Carroll, J., Carney, P. A., & Duberstein, P. R. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000204652.27246.5b · Cited by 136 · see citing works
Heartsink patients: a study of their general practitioners.
Mathers, N. J., Jones, N. S., & Hannay, D. (1995) · PubMed · Cited by 123 · see citing works
Symptoms as a source of medical knowledge: understanding medically unexplained disorders in women.
Malterud, K. (2000) · PubMed · Cited by 121 · see citing works
Predictors of physician frustration in the care of patients with rheumatological complaints
Walker, E. A., Katon, W. J., Keegan, D. A., Gardner, G. C., & Sullivan, M. (1997) · General Hospital Psychiatry · doi:10.1016/s0163-8343(97)00042-x · Cited by 91 · see citing works
Escobar, J. I., & Gureje, O. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31815b007e · Cited by 78 · see citing works
Difficult patients: black holes and secrets.
Gerrard, T. J., & Riddell, J. D. (1988) · BMJ · doi:10.1136/bmj.297.6647.530 · Cited by 72 · see citing works
Patient-Physician Shared Experiences and Value Patients Place on Continuity of Care
Mainous, A. G. (2004) · The Annals of Family Medicine · doi:10.1370/afm.84 · Cited by 71 · see citing works
Chew-Graham, C. A. (2004) · Family Practice · doi:10.1093/fampra/cmh301 · Cited by 62 · see citing works
Karasz, A., Dempsey, K., & Fallek, R. (2007) · Culture Medicine and Psychiatry · doi:10.1007/s11013-007-9066-y · Cited by 61 · see citing works
Blankenstein, A. H., van der Horst, H. E., Schilte, A. F., de Vries, D., Zaat, J. O. M., Knottnerus, J. A., van Eijk, J. T. M., & de Haan, M. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00199-9 · Cited by 53 · see citing works
Metaphorically transmitted diseases. How do patients embody medical explanations?
Mabeck, C. E. (1997) · Family Practice · doi:10.1093/fampra/14.4.271 · Cited by 52 · see citing works
Understanding and Caring for the Distressed Patient With Multiple Medically Unexplained Symptoms
Walker, E. A., Unützer, J., & Katon, W. J. (1998) · The Journal of the American Board of Family Medicine · doi:10.3122/15572625-11-5-347 · Cited by 43 · see citing works
Cape, J. D. (2000) · British Journal of Clinical Psychology · doi:10.1348/014466500163383 · Cited by 39 · see citing works
Rethinking the doctor-patient relationship in general practice
Dowrick, C. F. (2007) · Health & Social Care in the Community · doi:10.1111/j.1365-2524.1997.tb00089.x · Cited by 32 · see citing works
Dealing with the difficult patient.
Smith, S. (1995) · Postgraduate medical journal · doi:10.1136/pgmj.71.841.653 · Cited by 31 · see citing works
Hartman, T. O., Hassink-Franke, L., Dowrick, C. F., Fortes, S., Lam, C., van der Horst, H. E., Lucassen, P. L., & van Weel-Baumgarten, E. M. (2008) · Family Practice · doi:10.1093/fampra/cmn041 · Cited by 29 · see citing works
Self-citationDownes-Grainger, E., Morriss, R. K., Gask, L. L., & Faragher, B. E. (1998) · Psychological Medicine · doi:10.1017/s0033291798006552 · Cited by 25 · see citing works
The Foundations of Primary Care: v. 1, Satisfaction or Resentment?
Sturmberg, J. P., & Martin, C. M. (2007) · Cited by 25 · see citing works
To be a helpless helpoholic – GPs’ experiences of women patients with non-specific muscular pain
Lundh, C., Segesten, K. M., & Björkelund, C. (2004) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430410006756 · Cited by 19 · see citing works
Gray, D. P. (1988) · PubMed · Cited by 13 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Bass Ce Somatisation: Physical Symptoms and Psychological disorder 1990 Oxford: Blackwell
- Sturmberg JP The foundations of primary care Daring to be different 2007 Oxford - Seattle: Radcliffe Publishing Ltd
Cited by
Sorted by citations
Moretti, F., van Vliet, L., Bensing, J. M., Deledda, G., Mazzi, M. A., Rimondini, M., Zimmermann, C., & Fletcher, I. J. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.01.005 · Cited by 453 · see citing works
Murray, A., Toussaint, A. C., Althaus, A., & Löwe, B. (2015) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2015.11.002 · Cited by 154 · see citing works
Rosendal, M., Olde Hartman, T. C., Aamland, A., van der Horst, H., Lucassen, P., Budtz-Lilly, A., & Burton, C. (2017) · BMC Family Practice · doi:10.1186/s12875-017-0592-6 · Cited by 129 · see citing works
Self-citationJohansen, M., & Risør, M. B. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.11.015 · Cited by 120 · see citing works
Edwards, T. M., Stern, A., Clarke, D. D., Ivbijaro, G. O., & Kasney, L. M. (2010) · PubMed Central · Cited by 104 · see citing works
Stress and inflammatory biomarkers and symptoms are associated with bioimpedance measures
Tsigos, C., Stefanaki, C., Lambrou, G. Ι., Boschiero, D., & Chrousos, G. P. (2014) · European Journal of Clinical Investigation · doi:10.1111/eci.12388 · Cited by 82 · see citing works
Rask, M. T., Ørnbøl, E., Rosendal, M., & Fink, P. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000405 · Cited by 81 · see citing works
Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty
Bransfield, R. C., & Friedman, K. J. (2019) · Healthcare · doi:10.3390/healthcare7040114 · Cited by 75 · see citing works
Explanatory models of medically unexplained symptoms: a qualitative analysis of the literature.
van Ravenzwaaij, J., Hartman, T. O., van Ravesteijn, H., Eveleigh, R. M., van Rijswijk, E., & Lucassen, P. (2010) · PubMed Central · Cited by 74 · see citing works
Self-citationBaliatsas, C., KAMP, I. V., Hooiveld, M., Yzermans, J. C., & Lebret, E. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.02.008 · Cited by 63 · see citing works
NHG-Standaard Somatisch Onvoldoende verklaarde Lichamelijke Klachten (SOLK)
Hartman, T. O., Blankenstein, A. H., Molenaar, B., van den Berg, B. B., van der Horst, H. E., Arnold, I. A., Burgers, J. S., Wiersma, T., & Koch, H. (2013) · Pure Amsterdam UMC · Cited by 61 · see citing works
Hartman, T. O., Rosendal, M., Aamland, A., van der Horst, H. E., Rosmalen, J. G. M., Burton, C. D., & Lucassen, P. L. (2017) · BJGP Open · doi:10.3399/bjgpopen17x101061 · Cited by 57 · see citing works
Self-citationRamond‐Roquin, A., Bouton, C., Bègue, C., Petit, A., Roquelaure, Y., & Huez, J.-F. (2015) · Frontiers in Medicine · doi:10.3389/fmed.2015.00073 · Cited by 53 · see citing works
Houwen, J., Lucassen, P. L., Stappers, H. W., Assendelft, W. J., van Dulmen, S., & Hartman, T. O. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x692537 · Cited by 53 · see citing works
Self-citationHartman, T. O., van Rijswijk, E., van Dulmen, S., van Weel-Baumgarten, E. M., Lucassen, P. L., & van Weel, C. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.02.014 · Cited by 52 · see citing works
Self-citationBlame, shame and hopelessness: medically unexplained symptoms and the 'heartsink' experience.
Stone, L. (2014) · PubMed · Cited by 50 · see citing works
Explaining symptoms after negative tests: towards a rational explanation
Burton, C. D., Lucassen, P. L., Aamland, A., & Hartman, T. O. (2014) · Journal of the Royal Society of Medicine · doi:10.1177/0141076814559082 · Cited by 50 · see citing works
Self-citationStone, L. (2014) · BMC Family Practice · doi:10.1186/s12875-014-0192-7 · Cited by 46 · see citing works
Living with tinnitus and the health care journey: An interpretative phenomenological analysis.
Marks, E., Smith, P., & McKenna, L. (2019) · British Journal of Health Psychology · doi:10.1111/bjhp.12351 · Cited by 43 · see citing works
Communicating and Dealing with Uncertainty in General Practice: The Association with Neuroticism
Schneider, A., Wübken, M., Linde, K., & Bühner, M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102780 · Cited by 43 · see citing works
What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study.
Nunes, J., Ventura, T., Encarnação, R., Pinto, P. R., & Santos, I. R. (2013) · PubMed Central · Cited by 43 · see citing works
Morton, L., Elliott, A., Cleland, J., Deary, V., & Burton, C. D. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.08.015 · Cited by 42 · see citing works
Why Bioethics Should Be Concerned With Medically Unexplained Symptoms
O’Leary, D. (2018) · The American Journal of Bioethics · doi:10.1080/15265161.2018.1445312 · Cited by 42 · see citing works
Moulin, V., Akré, C., Rodondi, P., Ambresin, A., & Surı́s, J.-C. (2015) · Journal of Adolescence · doi:10.1016/j.adolescence.2015.10.003 · Cited by 39 · see citing works
Czachowski, S., Piszczek, E., Sowińska, A., & Hartman, T. O. (2011) · Family Practice · doi:10.1093/fampra/cmr065 · Cited by 38 · see citing works
Eriksen, T. E., & Risør, M. B. (2013) · Medicine Health Care and Philosophy · doi:10.1007/s11019-013-9501-5 · Cited by 38 · see citing works
Lehmann, M., Pohontsch, N. J., Zimmermann, T., Scherer, M., & Löwe, B. (2021) · BMC Family Practice · doi:10.1186/s12875-021-01397-w · Cited by 37 · see citing works
Maatz, A., Wainwright, M., Russell, A., Macnaughton, J., & Yiannakou, Y. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.09.005 · Cited by 33 · see citing works
den Boeft, M., Huisman, D., Morton, L., Lucassen, P. L., van der Wouden, J. C., Westerman, M. J., van der Horst, H. E., & Burton, C. D. (2016) · Family Practice · doi:10.1093/fampra/cmw113 · Cited by 29 · see citing works
Self-citationPoloni, N., Ielmini, M., Caselli, I., Ceccon, F., Bianchi, L., Isella, C., & Callegari, C. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00626 · Cited by 28 · see citing works
Rask, M. T., Andersen, R. S., Bro, F., Fink, P., & Rosendal, M. (2014) · BMC Family Practice · doi:10.1186/1471-2296-15-118 · Cited by 28 · see citing works
Stortenbeker, I. A., Stommel, W., van Dulmen, S., Lucassen, P. L., Das, E. H. H. J., & Hartman, T. O. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.109994 · Cited by 28 · see citing works
Self-citationHouwen, J., Lucassen, P. L., Verwiel, A., Stappers, H. W., Assendelft, W. J., Hartman, T. O., & van Dulmen, S. (2019) · BMC Family Practice · doi:10.1186/s12875-019-1049-x · Cited by 28 · see citing works
Self-citationExplaining medically unexplained symptoms: Somatizing patients’ responses in primary care
Aiarzagüena, J. M., Gaminde, I., Clemente, I., & Garrido, E. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.05.013 · Cited by 27 · see citing works
Perspectives on the clinical significance of functional pain syndromes in children
Simons, L. E., Basch, M. C., Chow, E., Logan, D. E., & Schechter, N. L. (2015) · Journal of Pain Research · doi:10.2147/jpr.s55586 · Cited by 26 · see citing works
How general practitioners understand and handle medically unexplained symptoms: a focus group study
Rasmussen, E. B., & Rø, K. I. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0745-2 · Cited by 25 · see citing works
Moulin, V., Akré, C., Rodondi, P., Ambresin, A., & Surı́s, J.-C. (2015) · Journal of Adolescence · doi:10.1016/j.adolescence.2015.10.010 · Cited by 25 · see citing works
den Boeft, M., Huisman, D., van der Wouden, J. C., Numans, M. E., van der Horst, H. E., Lucassen, P. L., & Hartman, T. O. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0451-x · Cited by 24 · see citing works
Self-citationRasmussen, E. B. (2017) · Sociology of Health & Illness · doi:10.1111/1467-9566.12581 · Cited by 23 · see citing works
O’Connell, N., Nicholson, T. R., Blackman, G., Tavener, J., & David, A. S. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.04.004 · Cited by 23 · see citing works
Management of patients with persistent medically unexplained symptoms: a descriptive study
Sitnikova, K., Pret-Oskam, R., Dijkstra‐Kersten, S. M. A., Leone, S. S., van Marwijk, H., van der Horst, H. E., & van der Wouden, J. C. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0791-9 · Cited by 21 · see citing works
van Westrienen, P. E., Pisters, M. F., Veenhof, C., & de Wit, N. J. (2019) · BMC Family Practice · doi:10.1186/s12875-019-0950-7 · Cited by 19 · see citing works
Lehmann, M., Jonas, C., Pohontsch, N. J., Zimmermann, T. P., Scherer, M., & Löwe, B. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109734 · Cited by 19 · see citing works
Symptom management for medically unexplained symptoms in primary care: a qualitative study
Gol, J. M., Terpstra, T., Lucassen, P. L., Houwen, J., van Dulmen, S., Hartman, T. O., & Rosmalen, J. G. M. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x701849 · Cited by 18 · see citing works
Self-citationBaarsma, M. E., Claassen, S. A., van der Horst, H. E., Hovius, J. W., & Sanders, J. M. (2022) · BMC Family Practice · doi:10.1186/s12875-022-01736-5 · Cited by 17 · see citing works
Barriers and facilitators in diagnosing axial spondyloarthritis: a qualitative study
Hay, C. A., Packham, J., Prior, J. A., Mallen, C. D., & Ryan, S. (2024) · Rheumatology International · doi:10.1007/s00296-024-05554-z · Cited by 17 · see citing works
Leusink, P., Teunissen, D. A. M., Lucassen, P. L., Laan, E. T. M., & Lagro-Janssen, A. L. M. (2018) · European Journal of General Practice · doi:10.1080/13814788.2017.1420774 · Cited by 17 · see citing works
Self-citationMedical Residents’ Experiences With Medically Unexplained Illness and Medically Unexplained Symptoms
Harsh, J., Hodgson, J. L., White, M. B., Lamson, A. L. S., & Irons, T. G. (2015) · Qualitative Health Research · doi:10.1177/1049732315578400 · Cited by 16 · see citing works
Hansen, H. S., Rosendal, M., Fink, P., & Risør, M. B. (2012) · ISRN Family Medicine · doi:10.5402/2013/541604 · Cited by 15 · see citing works
Rask, M. T., Carlsen, A. H., Budtz-Lilly, A., & Rosendal, M. (2016) · BMC Family Practice · doi:10.1186/s12875-016-0478-z · Cited by 15 · see citing works
Houwen, J., de Bont, O. A., Lucassen, P. L., Rosmalen, J. G. M., Stappers, H. W., Hartman, T. O., & van Dulmen, S. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.09.018 · Cited by 15 · see citing works
Self-citationWortman, M. S. H., van der Wouden, J. C., Twisk, J. W. R., Visser, B., Assendelft, W. J., van der Horst, H. E., & Hartman, T. O. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111178 · Cited by 14 · see citing works
Fragility, uncertainty, and healthcare
Rogers, W., & Walker, M. J. (2016) · Metamedicine · doi:10.1007/s11017-016-9350-3 · Cited by 14 · see citing works
Medically Unexplained Symptoms
Lipsitt, D. R., Joseph, R., Meyer, D. J., & Notman, M. T. (2015) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000055 · Cited by 13 · see citing works
van Westrienen, P. E., Pisters, M. F., Toonders, S. A. J., Gerrits, M. M. J. G., Veenhof, C., & de Wit, N. J. (2018) · JMIR Research Protocols · doi:10.2196/resprot.9404 · Cited by 13 · see citing works
Terpstra, T., Gol, J. M., Lucassen, P. L., Houwen, J., van Dulmen, S., Berger, M. Y., Rosmalen, J. G. M., & Hartman, T. O. (2019) · Family Practice · doi:10.1093/fampra/cmz032 · Cited by 13 · see citing works
Self-citationBekhuis, E., Gol, J. M., Burton, C. D., & Rosmalen, J. G. M. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x707369 · Cited by 13 · see citing works
Rask, M. T., Frostholm, L., Hansen, S. H., Petersen, M. W., Ørnbøl, E., & Rosendal, M. (2023) · Health Psychology Review · doi:10.1080/17437199.2022.2163917 · Cited by 12 · see citing works
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Veterans with Gulf War Illness perceptions of management strategies
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Hypochondriasis and Somatization Disorder: New Perspectives
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From hysteria to somatic symptom disorders: searching for a common psychopathological ground
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Kritisch beoordelen van een artikel over primair onderzoek
Offringa, M., Assendelft, W. J., Scholten, R. J. P. M., Leeflang, M., Bossuyt, P. M., Groenwold, R. H. H., Reitsma, J. B., de Laar, F. A. V., van Puijenbroek, E., Broeders, M. J. M., et al. (2018) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-1978-7_4 · Cited by 3 · see citing works
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(Not) “just your nature”. Diagnostic journeys of adults with neurofibromatosis type 1 in Poland
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4 Kritisch beoordelen van een artikel
Offringa, M., Assendelft, W. J., & Scholten, R. J. P. M. (2008) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6636-1_4 · Cited by 2 · see citing works
Misdrahi, S., Louët, E., Eymard, B., Gargiulo, M., & Luca, M. D. (2021) · L Évolution Psychiatrique · doi:10.1016/j.evopsy.2020.12.001 · Cited by 2 · see citing works
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Burton, C. D., Lucassen, P., Aamland, A., & Hartman, T. O. (2015) · Huisarts en Wetenschap · doi:10.1007/s12445-015-0253-8 · Cited by 1 · see citing works
Self-citation
- Authors
- olde Hartman, T. C., Hassink-Franke, L. J., Lucassen, P. L., van Spaendonck, K. P., & van Weel, C.
- Affiliations
- Radboud University Medical Center (NL)
- ORCID
- Lucassen, Peter L
- Venue
- BMC Family Practice
- Published
- 2009-09-24
- Volume
- 10
- Issue
- 1
- Pages
- 68-68
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC2758831
- OpenAlex
- W1989998067
- Cited by
- 127
- References
- 52
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 10 · 2020: 4 · 2019: 16 · 2018: 11 · 2017: 7 · 2016: 9 · 2015: 10 · 2014: 11 · 2013: 7 · 2012: 7
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- ZonMw
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- medically unexplained symptoms, persistent symptoms, general practitioners, physician-patient relationship, patient reassurance, alliance model, unnecessary interventions, patient return visits
- MeSH terms
- Adult, Attitude of Health Personnel, Communication, Family Practice, Female, Humans, Male, Middle Aged, Models, Psychological, Patient Acceptance of Health Care, Physician-Patient Relations, Physicians, Family, Referral and Consultation, Somatoform Disorders, Focus Groups
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