Primary care consultations about medically unexplained symptoms: how do patients indicate what they want?

doi:10.1007/s11606-008-0898-0

. 2009 Apr;24(4):450-6.

doi: 10.1007/s11606-008-0898-0. Epub 2009 Jan 23.

Primary care consultations about medically unexplained symptoms: how do patients indicate what they want?

Peter Salmon¹, Adele Ring, Gerry M Humphris, John C Davies, Christopher F Dowrick

Affiliations

PMID: 19165548
PMCID: PMC2659147
DOI: 10.1007/s11606-008-0898-0

Primary care consultations about medically unexplained symptoms: how do patients indicate what they want?

Peter Salmon et al. J Gen Intern Med. 2009 Apr.

. 2009 Apr;24(4):450-6.

doi: 10.1007/s11606-008-0898-0. Epub 2009 Jan 23.

Authors

Peter Salmon¹, Adele Ring, Gerry M Humphris, John C Davies, Christopher F Dowrick

Affiliation

¹ Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK. psalmon@liv.ac.uk

PMID: 19165548
PMCID: PMC2659147
DOI: 10.1007/s11606-008-0898-0

Abstract

Background: Patients with medically unexplained physical symptoms (MUS) are often thought to deny psychological needs when they consult general practitioners (GPs) and to request somatic intervention instead. We tested predictions from the contrasting theory that they are transparent in communicating their psychological and other needs.

Objective: To test predictions that what patients tell GPs when they consult about MUS is related transparently to their desire for (1) emotional support, (2) symptom explanation and (3) somatic intervention.

Design: Prospective naturalistic study. Before consultation, patients indicated what they wanted from it using a self-report questionnaire measuring patients' desire for: emotional support, explanation and reassurance, and physical investigation and treatment. Their speech during consultation was audio-recorded, transcribed and coded utterance-by-utterance. Multilevel regression analysis tested relationships between what patients sought and what they said.

Participants: Patients (N = 326) consulting 33 GPs about symptoms that the GPs designated as MUS.

Results: Patients who wanted emotional support spoke more about psychosocial problems, including psychosocial causes of symptoms and their need for psychosocial help. Patients who wanted explanation and reassurance suggested more physical explanations, including diseases, but did not overtly request explanation. Patients' wish for somatic intervention was associated only with their talk about details of such interventions and not with their requests for them.

Conclusions: In general, patients with medically unexplained symptoms provide many cues to their desire for emotional support. They are more indirect or guarded in communicating their desire for explanation and somatic intervention.

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Figures

**Figure 1**
Relationships between patients’ desire for emotional support and number of instances of specific speech codes. Graphs show the predicted cumulative effects of significant event rate ratios reported in Table 3. *Note that ordinate range is longer for this graph than all others.

**Figure 2**
Relationships between patients’ desire for explanation and reassurance, or investigation and treatment, and number of instances of specific speech codes. Graphs show the predicted cumulative effects of significant event rate ratios reported in Table 3.

See this image and copyright information in PMC

Comment in

Medically unexplained physical symptoms.
Jackson JL, George S, Hinchey S. Jackson JL, et al. J Gen Intern Med. 2009 Apr;24(4):540-2. doi: 10.1007/s11606-009-0932-x. J Gen Intern Med. 2009. PMID: 19255810 Free PMC article. No abstract available.

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References

1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0022-3999(96)00292-9', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0022-3999(96)00292-9'}, {'type': 'PubMed', 'value': '9130181', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9130181/'}]}
2. Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997;42:245–52. - PubMed
1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1177/0272989X03023003004', 'is_inner': False, 'url': 'https://doi.org/10.1177/0272989x03023003004'}, {'type': 'PubMed', 'value': '12809320', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12809320/'}]}
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1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.socscimed.2005.03.014', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.socscimed.2005.03.014'}, {'type': 'PubMed', 'value': '15922499', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15922499/'}]}
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1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.294.17.2152', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.294.17.2152'}, {'type': 'PubMed', 'value': '16264150', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16264150/'}]}
2. Lamberg L. New mind/body tactics target medically unexplained physical symptoms and fears. J Am Med Assoc. 2005;294:2152–4. - PubMed

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[1] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0022-3999(96)00292-9', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0022-3999(96)00292-9'}, {'type': 'PubMed', 'value': '9130181', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9130181/'}]}

Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997;42:245–52. - PubMed

[2] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0022-3999(96)00292-9', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0022-3999(96)00292-9'}, {'type': 'PubMed', 'value': '9130181', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9130181/'}]}

[3] Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997;42:245–52. - PubMed

[4] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1177/0272989X03023003004', 'is_inner': False, 'url': 'https://doi.org/10.1177/0272989x03023003004'}, {'type': 'PubMed', 'value': '12809320', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12809320/'}]}

van der Weijden T, van Velsen M, Dinant GJ, van Hasselt CM, Grol R. Unexplained complaints in general practice: prevalence, patients’ expectations, and professionals’ test-ordering behavior. Med Decis Making. 2003;23:226–31. - PubMed

[5] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1177/0272989X03023003004', 'is_inner': False, 'url': 'https://doi.org/10.1177/0272989x03023003004'}, {'type': 'PubMed', 'value': '12809320', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12809320/'}]}

[6] van der Weijden T, van Velsen M, Dinant GJ, van Hasselt CM, Grol R. Unexplained complaints in general practice: prevalence, patients’ expectations, and professionals’ test-ordering behavior. Med Decis Making. 2003;23:226–31. - PubMed

[7] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.socscimed.2005.03.014', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.socscimed.2005.03.014'}, {'type': 'PubMed', 'value': '15922499', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15922499/'}]}

Ring A, Dowrick CF, Humphris GM, Davies J, Salmon P. The somatising effect of clinical consultation: What patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med. 2005;61:1505–15. - PubMed

[8] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.socscimed.2005.03.014', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.socscimed.2005.03.014'}, {'type': 'PubMed', 'value': '15922499', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15922499/'}]}

[9] Ring A, Dowrick CF, Humphris GM, Davies J, Salmon P. The somatising effect of clinical consultation: What patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med. 2005;61:1505–15. - PubMed

[10] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.jpsychores.2004.04.369', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.jpsychores.2004.04.369'}, {'type': 'PubMed', 'value': '15596157', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15596157/'}]}

Arnold IA, Speckens AE, van Hemert AM. Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care. J Psychosom Res. 2004;57:517–20. - PubMed

[11] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.jpsychores.2004.04.369', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.jpsychores.2004.04.369'}, {'type': 'PubMed', 'value': '15596157', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15596157/'}]}

[12] Arnold IA, Speckens AE, van Hemert AM. Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care. J Psychosom Res. 2004;57:517–20. - PubMed

[13] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.294.17.2152', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.294.17.2152'}, {'type': 'PubMed', 'value': '16264150', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16264150/'}]}

Lamberg L. New mind/body tactics target medically unexplained physical symptoms and fears. J Am Med Assoc. 2005;294:2152–4. - PubMed

[14] {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.294.17.2152', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.294.17.2152'}, {'type': 'PubMed', 'value': '16264150', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/16264150/'}]}

[15] Lamberg L. New mind/body tactics target medically unexplained physical symptoms and fears. J Am Med Assoc. 2005;294:2152–4. - PubMed

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Primary care consultations about medically unexplained symptoms: how do patients indicate what they want?

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Primary care consultations about medically unexplained symptoms: how do patients indicate what they want?

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