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Primary Care Consultations About Medically Unexplained Symptoms: How Do Patients Indicate What They Want?

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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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Acknowledgments

The study was supported by the UK Medical Research Council. We are grateful for the enthusiastic cooperation of the participating general practitioners. Completion of the manuscript was assisted by the award of an Institute of Advanced Study Distinguished Fellowship by LaTrobe University to PS.

Contributors

PS led the design and bid for funding, data analysis and writing of the paper. CFD and GMH contributed to design and supervision of the study, data interpretation and writing. AR carried out data collection and transcript coding and contributed to design, data interpretation and writing. JCD designed and supervised data management and contributed to data analysis, interpretation and writing.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK

    Peter Salmon DPhil

  2. Division of Primary Care, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK

    Adele Ring PhD & Christopher F. Dowrick MD

  3. Bute Medical School, University of St Andrews, Fife, KY16 9TS, UK

    Gerry M. Humphris PhD

  4. Computing Services Department, University of Liverpool, Chadwick Tower, Liverpool, L69 3BX, UK

    John C. Davies PhD

Authors
  1. Peter Salmon DPhil
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  2. Adele Ring PhD
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  3. Gerry M. Humphris PhD
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  4. John C. Davies PhD
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  5. Christopher F. Dowrick MD
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Corresponding author

Correspondence to Peter Salmon DPhil.

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Salmon, P., Ring, A., Humphris, G.M. et al. Primary Care Consultations About Medically Unexplained Symptoms: How Do Patients Indicate What They Want?. J GEN INTERN MED 24, 450–456 (2009). https://doi.org/10.1007/s11606-008-0898-0

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  • DOI: https://doi.org/10.1007/s11606-008-0898-0

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