Multiple symptoms and health anxiety in primary care: a qualitative study of tensions and collaboration between patients and family physicians

Abstract

BackgroundPatients with multiple, persistent symptoms and health anxiety often report poor health outcomes. Patients who are difficult to reassure are challenging for family physicians. The therapeutic alliance between a physician and a patient can influence the prognosis of these patients. Optimising the quality of the physician–patient alliance may depend on a better understanding of the interpersonal processes that influence this relationship.ObjectiveThe purpose of this study is to understand the experiences of patients who experience multiple persistent symptoms or high health anxiety and their physicians when they interact.Design, participants and settingA qualitative study was conducted using grounded theory of 18 patients, purposively sampled to select patients who reported high physical symptom severity, high health anxiety or both, and 7 family physicians in the same clinic. This study was conducted at a family medicine clinic in a teaching hospital.ResultsA model of interpersonal tension and collaboration for patients and physicians in primary care was developed. Helpful attitudes and actions as well as troublesome topics influence crucial dilemmas between patients and physicians. These dilemmas include if patients feel heard and validated and the alignment of goals and mutual respect of expertise and experience between patients and physicians. These experiences contribute to a constructive collaboration and in turn positive outcomes.ConclusionsThis model of patient–physician interaction may facilitate providers to turn their attention away from the contentious topics and towards actions and attitudes that promote beneficial outcomes.

They didn't break me, because I’m going to keep going: A participatory study exploring access to health and social services for women living on a low income in Ontario, Canada

“…Un ejemplo de estos patrones de invisibilidad sucede cuando las participantes asisten al médico y los síntomas experimentados son ignorados por los profesionales de la salud. En la interacción entre paciente y profesional de la salud existen tópicos identificados como problemáticos y que acarrean conflicto entre los médicos y pacientes (Le et al, 2022;Taber et al, 2014). Cuando un paciente presenta síntomas que al investigar no parecen estar relacionados con una patología orgánica, estos síntomas suelen considerarse productos de problemas psicológicos o emocionales, y su legitimidad como asuntos 'médicos' a menudo es cuestionada.…”

“…Cuando un paciente presenta síntomas que al investigar no parecen estar relacionados con una patología orgánica, estos síntomas suelen considerarse productos de problemas psicológicos o emocionales, y su legitimidad como asuntos 'médicos' a menudo es cuestionada. Para los pacientes, el considerar estos síntomas como problemas psicológicos o de ansiedad es problemático, puesto que una enfermedad grave puede pasarse por alto (Le et al, 2022;Taber et al, 2015).…”