Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms
Open accessAbstract
Background: Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms. Aims: To determine if practice-based training of GPs in reattribution changes doctor–patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration. Method: Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual. Results: With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference −0.9, 95% CI −1.6 to −0.1; P=0.027) with no other effects on patient outcome or health contacts. Conclusions: Practice-based training in reattribution changed doctor–patient communication without improving outcome of patients with medically unexplained symptoms.
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Only 10%-15% of the 14 common physical symptoms seen in half of GP consultations over 12 months were found to be caused by an organic illness, resulting in 85-90% being of unknown biological aetiology.
“only 10% -15% of the 14 common, physical symptoms seen in half of GP consultations over 12 months were found to be caused by an organic illness (Morriss, Dowrick, Salmon, 2007), resulting in 85-90% being of unknown biological aetiology.”
From Clinical outcomes from The BodyMind Approach™ in the treatment of patients with medically unexplained symptoms in primary health care in England: Practice-based evidence (2016) · cites this paper as Morriss et al., 2007
The introduction says medically unexplained symptoms are common in primary care, but it gives none of the claimed figures. The Results and Possible methodological limitations sections describe this trial’s patients, not 14 symptoms across GP consultations over 12 months. Searches for the 10–15% organic-cause figure and the resulting 85–90% figure found no supporting passage in our copy; page numbers were unavailable. (LLM, conf=0.73)
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- Authors
- Morriss, R., Dowrick, C., Salmon, P., Peters, S., Dunn, G., Rogers, A., Lewis, B., Charles-Jones, H., Hogg, J., Clifford, R., Rigby, C., & Gask, L.
- Affiliations
- University of Nottingham (GB)
- University of Liverpool (GB)
- University of Manchester (GB)
- Health Education North West (GB)
- Corresponding author
- Morriss, Richard
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2007-12
- Volume
- 191
- Issue
- 6
- Pages
- 536-542
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2117435902
- Semantic Scholar
- d688df3b6af30621de8364d8745831c6b4656983
- Cited by
- 112
- References
- 30
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 5 · 2014: 3 · 2013: 11 · 2012: 14
- FWCI
- 6.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, other-oa)
- Funders
- Medical Research Council
- 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 › Psychiatry and Mental health › Medicine, History, and Philosophy
- Keywords
- reattribution, medically unexplained symptoms, general practice training, physician-patient communication, psychological explanation, quality of life, primary care
- MeSH terms
- Workforce, Communication, Education, Medical, Continuing, Female, Humans, Male, Mental Health Services, Middle Aged, Physician-Patient Relations, Somatoform Disorders, Reproducibility of Results, Program Evaluation, Cluster Analysis, Problem-Based Learning
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