A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Morton, LaKrista; Elliott, Alison M; Cleland, Jennifer; Deary, Vincent; Burton, Christopher

doi:10.1016/j.pec.2016.08.015

Cited by 31 publications

(28 citation statements)

References 33 publications

(43 reference statements)

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“…Showing empathy with patients with MUS helps to lower patient anxiety and improve satisfaction [44]. Additionally, different types of explanations could also have important implications for patients with MUS [45] and the extent to which they accept the message [46]. This study adds to the current field of research by targeting a specific yet important aspect of communication rather than a more generic approach to communication.…”

Section: Message Directness In Relation To Patient Anxietymentioning

confidence: 94%

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Stortenbeker

Houwen

Lucassen

et al. 2018

Patient Education and Counseling

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Section: Message Directness In Relation To Patient Anxietymentioning

confidence: 94%

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Stortenbeker

Houwen

Lucassen

et al. 2018

Patient Education and Counseling

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show abstract

“…30 A recent study examined 138 audiotaped explanations given to patients with MUPS and identified three components: facts, mechanisms, and causes. 32 The analysis presented here substantiates how GPs may feel insecure about offering such explanations due to lack of biomedical knowledge and the need for pragmatic adaptations of popular explanations. However, in contrast with a study by Stone, 26 the findings presented here clearly substantiate how experienced GPs may be able to incorporate physical as well as psychological aspects into their explanations.…”

Section: Strengths and Limitationsmentioning

confidence: 52%

Helpful strategies for GPs seeing patients with medically unexplained physical symptoms: a focus group study

et al. 2017

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GPs use tangible, down-to-earth strategies in consultations with patients with MUPS. Important strategies were: thorough investigation of the patient's symptoms and story; sharing of interpretations; and negotiation of different explanations. Sharing helpful strategies with colleagues in a field in which frustration and dissatisfaction are not uncommon can encourage GPs to develop sustainable responsibility and innovative solutions.

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“…Without a clear physiological basis, it is difficult to target a therapeutic approach. This leads to challenges in communicating ambiguity about causal features and certainty about predicted outcomes (Morton, Elliott, Cleland, Deary, & Burton, 2017;Salmon, 2007;Stone, 2014). Within hearing health care, this has been documented in descriptions of patient help-seeking and coping in King-Kopetzky syndrome (Pryce & Wainwright, 2008).…”

Section: Statement Of Contributionmentioning

confidence: 99%

Shared decision‐making in tinnitus care – An exploration of clinical encounters

Pryce

Hall

Marks

et al. 2018

British J Health Psychol

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ObjectivesThis study examined clinical encounters between clinicians and patients to determine current practice for the diagnosis and treatment of tinnitus. The objective was to develop an understanding of the ideal clinical encounter that would facilitate genuine shared decision‐making.DesignVideo ethnography was used to examine clinical encounters for the diagnosis and treatment of tinnitus.MethodsClinical encounters were video‐recorded. Patients were interviewed individually following their clinic appointment. Data were analysed using constant comparison techniques from Grounded Theory. Initial inductive analyses were then considered against theoretical conceptualizations of the clinician–patient relationship and of the clinical encounter.ResultsAlignment between clinician and patient was found to be essential to a collaborative consultation and to shared decision‐making. Clinician groups demonstrated variation in behaviour in the encounter; some asked closed questions and directed the majority of the consultation; others asked open questions and allowed patients to lead the consultation.ConclusionsA shift away from aetiology and physiological tests is needed so that tinnitus is managed as a persistent unexplained set of symptoms. This uncertainty is challenging for the medical professionals; lessons could be learned from the use of therapeutic skills. Further research is required to test techniques, such as the use of decision aids, to determine how we might create the ideal clinical encounter. Statement of contribution What is already known on this subject? Tinnitus is a condition in which sound is heard in the absence of an external source. Current approaches to managing tinnitus vary depending on clinical site (Hoare & Hall, 2011).In most instances, tinnitus does not have a straightforward medical cause. Tinnitus care is challenging to traditional biomedical encounters because the process of diagnosis may not lead to a defined treatment.Clinicians are required to consider not only what the tinnitus sounds like but more importantly, what it means for the affected individual. This requires a careful and skilled approach to eliciting a patient's current behaviour, coping, and preferences for both outcomes and treatment approaches. What does this study add? We provide the first in‐depth description of decision‐making in clinical services for tinnitus.Findings suggest a shift in focus is required to move away from the current prioritization of the biomedical treatment of tinnitus.There is variation to the extent different clinicians were able to deal with the uncertainty presented by the symptoms of tinnitus.

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A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Cited by 31 publications

References 33 publications

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Quantifying positive communication: Doctor’s language and patient anxiety in primary care consultations

Helpful strategies for GPs seeing patients with medically unexplained physical symptoms: a focus group study

Shared decision‐making in tinnitus care – An exploration of clinical encounters

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