Explanations for medically unexplained symptoms: a qualitative study on GPs in daily practice consultations

Abstract

Background General practice is the centre of care for patients with medically unexplained symptoms (MUS). Providing explanations for MUS, i.e. making sense of symptoms, is considered to be an important part of care for MUS patients. However, little is known how general practitioners (GPs) do this in daily practice. Objective This study aimed to explore how GPs explain MUS to their patients during daily general practice consultations. Methods A thematic content analysis was performed of how GPs explained MUS to their patients based on 39 general practice consultations involving patients with MUS. Results GP provided explanations in nearly all consultations with MUS patients. Seven categories of explanation components emerged from the data: defining symptoms, stating causality, mentioning contributing factors, describing mechanisms, excluding explanations, discussing the severity of symptoms and normalizing symptoms. No pattern of how GPs constructed explanations with the various categories was observed. In general, explanations were communicated as a possibility and in a patient-specific way; however, they were not very detailed. Conclusion Although explanations for MUS are provided in most MUS consultations, there seems room for improving the explanations given in these consultations. Further studies on the effectiveness of explanations and on the interaction between patients and GP in constructing these explanations are required in order to make MUS explanations more suitable in daily primary care practice.

Experiences of general practitioners explaining central sensitisation to patients with persistent physical symptoms: a focus group study

“…They did not use more detailed explanations, only a few GPs used the sensitisation model. 34 In our study, very few GPs had used CS as explanatory model before receiving the training.…”

“… 17 33 Even experienced GPs have a limited set of explanatory models at their disposal. 34 Burton et al provide six criteria for a rational explanation: the explanation must be plausible, not imply blame or weakness, promote therapeutic collaboration, apply a descriptive label, address causation and be created through dialogue. 35 den Boeft et al found four dialogue types in consultations with patients with PPS: lecture, storytelling, contest and deliberation; cocreated explanations can be seen as a fifth type and are the most likely to be accepted.…”

“…Explanations should be focused, practical and in the patient’s language, according to the guidelines 17 33. Even experienced GPs have a limited set of explanatory models at their disposal 34. Burton et al provide six criteria for a rational explanation: the explanation must be plausible, not imply blame or weakness, promote therapeutic collaboration, apply a descriptive label, address causation and be created through dialogue 35.…”

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