Primary Care Physicians Treat Somatization

Smith, Robert C.; Gardiner, Joseph C.; Luo, Zhehui; Schooley, Susan; Lamerato, Lois; Rost, Kathryn

doi:10.1007/s11606-009-0992-y

Cited by 38 publications

(19 citation statements)

References 19 publications

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“…Smith and his colleagues [46] in the United States have particularly advanced the field in developing a multidimensional intervention based on three principles from the literature which seemed to be effective: collaborative/stepped care, the use of cognitive-behavioural therapy skills and the centrality of the patient-provider relationship in working with patients with medically unexplained symptoms [46]. This model, which has similarities to that described by van der Feltz-Cornelis who combined aspects of reattribution training, cognitive-behavioural skills and consultation liaison [28] has recently been piloted successfully with moderatelarge effect sizes reported [47] and in parallel qualitative research [48] the authors have reported:…”

Section: Comparison With Other Approaches In the Literaturementioning

confidence: 99%

Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Gask

Dowrick

Salmon

et al. 2011

Journal of Psychosomatic Research

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Section: Comparison With Other Approaches In the Literaturementioning

confidence: 99%

Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Gask

Dowrick

Salmon

et al. 2011

Journal of Psychosomatic Research

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“…Twenty studies met the inclusion criteria for the present meta-analysis [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58]. We identified 850 records through database searching and screening of reference lists of previous systematic reviews and meta-analyses.…”

Section: Resultsmentioning

confidence: 99%

Does It Matter Who Provides Psychological Interventions for Medically Unexplained Symptoms? A Meta-Analysis

Gerger

Hlavica

Gaab

et al. 2015

Psychother Psychosom

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Background: Patients with medically unexplained symptoms (MUS) are difficult to treat and cause high health-care costs. Psychological interventions might be a beneficial option for treating patients with MUS, but evidence is inconsistent. This meta-analysis compares the effectiveness of psychological interventions for MUS - delivered either by psychotherapists (PTs) or by general practitioners (GPs) - with that of usual care. Method: We conducted a systematic review and meta-analysis on randomised controlled trials of psychological interventions for MUS. Physical symptoms were the primary outcome, and physical functioning and psychological symptoms were the secondary outcomes. We pooled between-group effect sizes (ESs) after the treatment and at the follow-up in random-effects meta-regressions and stratified meta-analyses. We repeated these analyses with the intervention provider, intervention dose, MUS severity and methodological quality as predictors of relative intervention effects. Results: A total of 3,225 patients in 20 studies were analysed. After the treatment, small and significant ESs were found for all 3 outcome domains (ES range: 0.13-0.19, all p < 0.05). Psychological interventions were more beneficial for physical symptoms when delivered by PTs than by GPs (p = 0.02). There was no difference between PTs and GPs in terms of physical functioning and psychological symptoms. Conclusion: Psychological interventions are effective for patients with MUS, but the effects are small and most likely of short duration. Interventions that are delivered by PTs appear to have larger effects on unexplained physical symptoms than those delivered by GPs. Whether this superiority is due to a larger number of sessions of PT interventions remains unclear from our findings.

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“…27 Studies suggest physicians tend to default toward prescribing medications with dubious benefits to patients with MUS, even when those patients are not asking for pharmacological treatment. 28 Research indicates that medication, 29,30 cognitive-behavioral therapy, 31 and patient-centered management 32,33 may help relieve MUS, though there are contradictory findings. 34,35 It seems reasonable in a biopsychosociospiritual 9,10 model for physicians to explore all options with the patient, but our results demonstrate that physicians' religious characteristics and specialty will influence which option a physician prefers, and how they interpret the cause of MUS.…”

Section: Discussionmentioning

confidence: 99%

A Spiritual Problem? Primary Care Physicians’ and Psychiatrists’ Interpretations of Medically Unexplained Symptoms

et al. 2012

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BACKGROUND:Patients commonly present to their physicians with medically unexplained symptoms (MUS), and there is no consensus about how physicians should interpret or treat such symptoms. OBJECTIVE: To examine how variations in physicians' interpretations of MUS are associated with physicians' religious characteristics and with physician specialty (primary care vs. psychiatry). DESIGN AND PARTICIPANTS: A national survey of a stratified random sample of 1,504 primary care physicians and 512 psychiatrists in 2009-2010. MAIN MEASURES: The extent to which physicians believe MUS reflect a root problem that is spiritual in nature or result from conditions that scientific research will eventually explain, and whether such patients would benefit from attention to their relationships, attention to their spiritual life, taking medications, and/or treatment by physicians. KEY RESULTS: Response rate was 63 % (1,208/ 1,909). More religious/spiritual physicians were more likely to believe that MUS reflect a spiritual problem (55 % for high vs. 24 % for low spirituality; OR=2.8, 1.7-4.5) and that these patients would benefit from paying attention to their spiritual life (79 % for high vs. 55 % for low spirituality; OR=3.1, 1.8-5.3). Psychiatrists were more likely to believe that scientific research will one day explain MUS (66 % vs. 52 %; OR= 1.9, 1.4-2.5) and that these symptoms will improve with treatment by a physician (54 % vs. 35 %; OR=2.4, 1.8-3.3). They were less likely to believe that MUS reflect a spiritual problem (23 % vs. 38 %; OR=0.5, 0.4-0.8). CONCLUSIONS: Physicians' interpretations of MUS vary widely, depending in part on physicians' religious characteristics and specialty. One in three physicians believes that patients with MUS have root problems that are spiritual in nature. Physicians who are more religious or spiritual are more likely to think of MUS as stemming from spiritual concerns. Psychiatrists are more optimistic that these patients will get better with treatment by physicians.

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Primary Care Physicians Treat Somatization

Cited by 38 publications

References 19 publications

Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Does It Matter Who Provides Psychological Interventions for Medically Unexplained Symptoms? A Meta-Analysis

A Spiritual Problem? Primary Care Physicians’ and Psychiatrists’ Interpretations of Medically Unexplained Symptoms

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