General practitioners' responses to the initial presentation of medically unexplained symptoms: A quantitative analysis

被引：14
作者：
Kappen T. [1 ]
van Dulmen S. [1 ]
机构：
[1] NIVEL (Netherlands Institute for Health Services Research), 3500 BN Utrecht
来源：
BioPsychoSocial Medicine | / 2卷 / 1期
关键词：
Physical Symptom; Medical Visit; Medically Unexplained Symptom; Unexplained Symptom; Medical Exploration;
D O I：
10.1186/1751-0759-2-22
中图分类号：
学科分类号：
摘要：
Background: Physicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms (MUS). In order to solve their patients' problems and out of a fear of overlooking a serious disease, many physicians give their patients full physical examinations and interventions, thereby incorrectly confirming the somatic nature of their condition. Preventing somatization could be achieved by examining the patient's symptom presentation for clues to underlying psychosocial issues and by an appropriate physician response. Methods: Ninety-seven videotaped medical visits from primary care patients presenting MUS for the first time were analyzed. Patients' presentations were categorized in: (1) symptoms only; (2) symptoms with a clue to an underlying concern; or (3) symptoms with an explicit concern. General practitioners' (GPs') responses to patients' presentation were classified into ignoring or more or less exploring responses. Exploring responses were further subdivided in non-directional explorations, clue explorations and medical explorations. Results: Results show that most patients presented their symptoms together with a reference to an underlying concern. Yet, most of them did so in an implicit way. GPs usually explored the concern presented by the patients, but most often in a medical way only. Conclusion: To address the potential psychological basis of patients' medically unexplained symptoms, GPs should pay more attention to the specific clues patients present to them. Likewise, in order to receive full attention, patients should try to present their concerns more explicitly. © 2008 Kappen and van Dulmen; licensee BioMed Central Ltd.
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