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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 (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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Metadata
- 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 › Medicine › Family Practice › 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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