Unexplained symptoms in primary care: perspectives of doctors and patients

Hartz, Arthur J.; Noyes, Russell; Bentler, Suzanne E.; Damiano, Peter C.; Willard, Jean C.; Momany, Elizabeth T.

doi:10.1016/s0163-8343(00)00060-8

Cited by 107 publications

(89 citation statements)

References 26 publications

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“…Continuity of care is highly valued by patients 23 and in the US has been shown to be associated with the confidence felt by primary care physicians in managing MUS. 24 Current policy within UK primary care values access before continuity, meaning that it is now more difficult for people with complex chronic problems to achieve continuity of care with an individual provider.…”

Section: Discussionmentioning

confidence: 99%

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

et al. 2008

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BACKGROUND: Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health. OBJECTIVE:To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.DESIGN: Qualitative study. PARTICIPANTS:Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general. APPROACH: Thematic analysis of in-depth interviews.RESULTS: Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.CONCLUSIONS: Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.

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Section: Discussionmentioning

confidence: 99%

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

et al. 2008

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“…Optimal provider-patient communication about chronic pain is important for several reasons: (1) there are numerous treatments for chronic pain that vary significantly in their invasiveness, effectiveness, and possible complications, and there is ambiguity regarding what constitutes the best treatment for a given patient; (2) patients often report concerns related to providers' views of the legitimacy of their pain complaints, which may affect disclosure and engagement [30][31][32][33][34]; and (3) engaging patients in self management is often essential to achieving adequate symptom relief and improving quality of life [11][12][13][14][15][35][36][37]. Collaboration often begins by identifying problems and shared goals.…”

Section: Patient-centered Pain Carementioning

confidence: 99%

Providers' roles in enhancing patients' adherence to pain self management

Dorflinger

Kerns

Auerbach

2012

Behav. Med. Pract. Policy Res.

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Practice guidelines and empirical research related to pain management encourage clinicians to take active roles in providing education about self management and promoting adoption of a self-management approach. The purpose of the study was to review the relevant literature, summarize aspects of the patientprovider interaction that influence patient engagement in self management for chronic pain, and outline practice recommendations in this area. Review of the literature on aspects of the patient-provider interaction that promote engagement in pain self-management was used. Findings are synthesized into recommendations for providers. Patients benefit from a biopsychosocial and patient-centered approach. Patients are more likely to fully disclose when providers respond empathically, which can improve conceptualization and treatment. Patient education and motivation play important roles in engaging patients in self management. Self management is influenced in part by the patient-provider communication process. Suggestions for communication strategies to facilitate patient engagement in self-management techniques, including empathic discussion of barriers and motivation enhancement, are provided. KEYWORDSChronic pain, Self management, Doctor-patient communication, Patient-centered care, Adherence Pain is one of the most common presenting problems in medical settings [1], and the majority of pain treatment tends to be carried out in the primary care context [2]. Pain that persists beyond 3 months and that does not remit with typical treatments for acute pain, such as rest, non-steroidal anti-inflammatory drugs, and heat or ice, is considered chronic pain. It is estimated that more than 100 million Americans have chronic pain [3], and prevalence in other countries varies from about 10-50 % of the general population [4]. Not only is chronic pain a prevalent health issue but it also significantly impacts quality of life [5][6][7][8] and the costs of care, and lost productivity are estimated to total almost $635 billion each year [3].Pain guidelines have recommended selfmanagement strategies in the treatment of chronic pain [9,10]. Self management differs from other treatments such as surgery and medication in that it emphasizes the patient's own control over his/her pain experience rather than relying on external factors to treat pain symptoms. At its most rudimentary level, self management consists of basic methods such as distraction, physical activity, and ice or heat to manage pain. Many patients use these practices on their own or are able to easily implement them after receiving reassurance and encouragement from their providers. Other patients may benefit from additional self-management techniques, such as those emphasized in cognitivebehavioral treatment for chronic pain, that aim to modify the thoughts and behaviors that contribute to the maintenance and exacerbation of pain. Such self-management skills include time-based pacing, relaxation, stress management, and identifying and modifying catastrophic ...

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“…Patients with medically unexplained symptoms (MUS) have as poor a quality of life as those with comparable symptoms caused by disease 6,7 . Many doctors find these patients challenging [8][9][10][11][12] and provide disproportionate levels of health care, which is often ineffective and might sometimes increase patients' dependence 7,[13][14][15] .…”

Section: Introductionmentioning

confidence: 99%