Management of somatisers in primary care: are family doctors motivated?

Abstract

Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.

Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

“…Previous reports, based on interviews about generalized attitudes in unselected practitioners, suggested that they find patients with MUS difficult or have negative views of them 5,7,8,20,33. Our study indicates a more complex picture, characterized by variability between practitioners and by tension between different parts of their accounts.…”

“…Whereas previous reports described practitioners’ attitudes to MUS,5,7,8,20,33,34 our analysis extended to an interpretative level that suggested psychological functions of attitudes that have hitherto been regarded as primary. Interview studies can be compromised by respondents’ tendency to speak in socially desirable ways.…”

“…Emphasis on clinical relationship did not, however, distinguish those who declined training from those who accepted it. Negative attitudes to patients suggest barriers to engagement, and previous writers have suggested that these should be explicitly targeted by programs to improve the care of MUS 5. However, these attitudes were belied by evidence that the GPs who displayed them did engage psychologically with their MUS patients.…”

“…To focus on changing GPs’ negative attitudes to these patients, as previously advocated,5 is probably mistaken. First, we need to understand whether some GPs are particularly challenged by psychological demands that patients with MUS present, and whether this accounts for their devaluing psychological skills.…”

Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

“…Previous reports, based on interviews about generalized attitudes in unselected practitioners, suggested that they find patients with MUS difficult or have negative views of them 5,7,8,20,33. Our study indicates a more complex picture, characterized by variability between practitioners and by tension between different parts of their accounts.…”

“…Whereas previous reports described practitioners’ attitudes to MUS,5,7,8,20,33,34 our analysis extended to an interpretative level that suggested psychological functions of attitudes that have hitherto been regarded as primary. Interview studies can be compromised by respondents’ tendency to speak in socially desirable ways.…”

“…Emphasis on clinical relationship did not, however, distinguish those who declined training from those who accepted it. Negative attitudes to patients suggest barriers to engagement, and previous writers have suggested that these should be explicitly targeted by programs to improve the care of MUS 5. However, these attitudes were belied by evidence that the GPs who displayed them did engage psychologically with their MUS patients.…”

“…To focus on changing GPs’ negative attitudes to these patients, as previously advocated,5 is probably mistaken. First, we need to understand whether some GPs are particularly challenged by psychological demands that patients with MUS present, and whether this accounts for their devaluing psychological skills.…”

Symptom management for medically unexplained symptoms in primary care: a qualitative study

“…This fits with the observation that patients with MUS identified the absence of a specific management plan as one of the problems experienced in the consultation, with GPs unclear about what patients should do after leaving the consultation room. 34 That the potential of symptom management is not fully used seems in line with GPs finding MUS difficult to manage, 9,10,[35][36][37][38][39] and evidence suggesting that GPs think effective treatments are lacking. 9 In addition, relevant information regarding symptom management, such as information on characteristics of MUS patients who are most likely to respond, is lacking.…”

Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

“…Previous reports, based on interviews about generalized attitudes in unselected practitioners, suggested that they find patients with MUS difficult or have negative views of them 5,7,8,20,33. Our study indicates a more complex picture, characterized by variability between practitioners and by tension between different parts of their accounts.…”

“…Whereas previous reports described practitioners’ attitudes to MUS,5,7,8,20,33,34 our analysis extended to an interpretative level that suggested psychological functions of attitudes that have hitherto been regarded as primary. Interview studies can be compromised by respondents’ tendency to speak in socially desirable ways.…”

“…Emphasis on clinical relationship did not, however, distinguish those who declined training from those who accepted it. Negative attitudes to patients suggest barriers to engagement, and previous writers have suggested that these should be explicitly targeted by programs to improve the care of MUS 5. However, these attitudes were belied by evidence that the GPs who displayed them did engage psychologically with their MUS patients.…”

“…To focus on changing GPs’ negative attitudes to these patients, as previously advocated,5 is probably mistaken. First, we need to understand whether some GPs are particularly challenged by psychological demands that patients with MUS present, and whether this accounts for their devaluing psychological skills.…”

Symptom management for medically unexplained symptoms in primary care: a qualitative study

“…This fits with the observation that patients with MUS identified the absence of a specific management plan as one of the problems experienced in the consultation, with GPs unclear about what patients should do after leaving the consultation room. 34 That the potential of symptom management is not fully used seems in line with GPs finding MUS difficult to manage, 9,10,[35][36][37][38][39] and evidence suggesting that GPs think effective treatments are lacking. 9 In addition, relevant information regarding symptom management, such as information on characteristics of MUS patients who are most likely to respond, is lacking.…”

Why do General Practitioners Decline Training to Improve Management of Medically Unexplained Symptoms?

“…Previous reports, based on interviews about generalized attitudes in unselected practitioners, suggested that they find patients with MUS difficult or have negative views of them 5,7,8,20,33. Our study indicates a more complex picture, characterized by variability between practitioners and by tension between different parts of their accounts.…”

“…Whereas previous reports described practitioners’ attitudes to MUS,5,7,8,20,33,34 our analysis extended to an interpretative level that suggested psychological functions of attitudes that have hitherto been regarded as primary. Interview studies can be compromised by respondents’ tendency to speak in socially desirable ways.…”

“…Emphasis on clinical relationship did not, however, distinguish those who declined training from those who accepted it. Negative attitudes to patients suggest barriers to engagement, and previous writers have suggested that these should be explicitly targeted by programs to improve the care of MUS 5. However, these attitudes were belied by evidence that the GPs who displayed them did engage psychologically with their MUS patients.…”

“…To focus on changing GPs’ negative attitudes to these patients, as previously advocated,5 is probably mistaken. First, we need to understand whether some GPs are particularly challenged by psychological demands that patients with MUS present, and whether this accounts for their devaluing psychological skills.…”

Symptom management for medically unexplained symptoms in primary care: a qualitative study

“…This fits with the observation that patients with MUS identified the absence of a specific management plan as one of the problems experienced in the consultation, with GPs unclear about what patients should do after leaving the consultation room. 34 That the potential of symptom management is not fully used seems in line with GPs finding MUS difficult to manage, 9,10,[35][36][37][38][39] and evidence suggesting that GPs think effective treatments are lacking. 9 In addition, relevant information regarding symptom management, such as information on characteristics of MUS patients who are most likely to respond, is lacking.…”