Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

Boeft, Madelon den; Huisman, Danielle; Wouden, Johannes C. van der; Numans, Mattijs E.; Horst, Henriëtte E. van der; Lucassen, Peter; Hartman, Tim olde

doi:10.1186/s12875-016-0451-x

Cited by 18 publications

(16 citation statements)

References 30 publications

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“…First, regarding the negative effects of biomedical framing of MUS, studies typically report that GPs experience negative emotions when working with MUS, such as uncertainty, fear, frustration and powerlessness [ 2 , 3 , 37 – 41 ]. Yet few studies attempt to understand the cause of the negative emotions on a deeper level.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the GPs ‘felt they had the opportunity to ‘know’ such patients better (than other doctors), and build a relationship upon which successful management could be based’ [ 39 ]. GPs are also typically reported to explain MUS by considering the sick person in his or her psychosocial context [ 2 , 3 , 37 , 39 , 40 , 48 – 50 ]. While the link between this understanding and a form of biopsychosocial framing is rarely explicated, it is certainly indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Medically unexplained symptoms (MUS) is an umbrella term used to refer to various symptoms that ‘have no identified organic basis’ [ 1 ], and ‘for which no adequate medical explanation can be found after a proper medical examination’ [ 2 ]. As such, MUS force general practitioners (GPs) to base clinical judgements on something other than biomedical evidence [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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How general practitioners understand and handle medically unexplained symptoms: a focus group study

Rasmussen

Rø

2018

BMC Fam Pract

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BackgroundMedically unexplained symptoms (MUS) are a common yet challenging encounter in primary care. The aim of this study was to explore how general practitioners (GPs) understand and handle MUS.MethodsThree focus group interviews were conducted with a total of 23 GPs. Participants with varied clinical experience were purposively recruited. The data were analysed thematically, using the concept of framing as an analytical lens.ResultsThe GPs alternated between a biomedical frame, centred on disease, and a biopsychosocial frame, centred on the sick person. Each frame shaped the GPs’ understanding and handling of MUS. The biomedical frame emphasised the lack of objective evidence, problematized subjective patient testimony, and manifested feelings of uncertainty, doubt and powerlessness. This in turn complicated patient handling. In contrast, the biopsychosocial frame emphasised clinical experience, turned patient testimony into a valuable source of information, and manifested feelings of confidence and competence. This in turn made them feel empowered. The GPs with the least experience relied more on the biomedical frame, whereas their more seasoned seniors relied mostly on the biopsychosocial frame.ConclusionThe biopsychosocial frame helps GPs to understand and handle MUS better than the biomedical frame does. Medical students should spend more time learning biopsychosocial medicine, and to integrate the clinical knowledge of their peers with their own.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0745-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How general practitioners understand and handle medically unexplained symptoms: a focus group study

Rasmussen

Rø

2018

BMC Fam Pract

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“…A recent study showed that GPs take various characteristics like multiple MUPS, frequent and long consultations and many referrals into account when recognising MUPS in their patients. 31 Equally, in case of uncertain VVC, GPs should be aware that the increasing number of consultations and comorbidity of MUPS could point to PVD.…”

Section: Discussionmentioning

confidence: 99%

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database

Leusink¹,

Moorsel²,

Bor³

et al. 2017

BJGP Open

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BackgroundA recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs.AimTo investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management.Design & settingAn observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database.MethodWomen with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected.ResultsIn total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001).ConclusionThis study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.

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“…We evaluated the matching of exercises to perpetuating factors with the help of eight experienced mental healthcare professionals. Based on a qualitative study describing prototypes of FSS patients (Den Boeft et al, 2016), we created five cases with video vignettes and a short description containing information on patient characteristics. These five prototypical patients varied widely with regard to relevant perpetuating factors.…”

Section: Methods Used For the Development Of The Grip Self-help Intermentioning

confidence: 99%

Development of Grip self-help: An online patient-tailored self-help intervention for functional somatic symptoms in primary care

Rosmalen

Gils

Acevedo-Mesa

et al. 2020

Internet Interventions

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Functional Somatic Symptoms (FSS) are somatic symptoms for which no somatic cause can be identified despite adequate diagnostic testing. FSS are common, costly, and disabling, and treatment options are limited.Psychotherapy is one of few evidence-based treatments for FSS. Yet, this form of therapy is not widely used, since it is usually reserved for severe symptoms, requires a highly trained therapist, and is not well accepted by patients.The current paper describes the development of the online intervention ‘Grip self-help’ and provides a description of the intervention itself. Grip self-help is an early intervention for mild to moderate FSS in primary care, which aims to reduce somatic symptoms and improve quality of life.In the Grip self-help intervention, patients fill out a set of online questionnaires exploring unhelpful cognitions, emotions, behaviors, and social factors associated with the symptoms. Using this information, a personal profile is generated, identifying factors that might maintain FSS in that individual. As a next step, patients are offered online self-help exercises that are tailored to these factors. Guidance is offered by a primary care professional. The intervention will ultimately result in a personalized self-help guide, composed of texts that are extracted from the exercises patients found useful during the intervention.Grip self-help is the first intervention for FSS combining the concepts of e-health, self-help, and personalized medicine. Guided by a primary care professional, patients are offered an easily accessible, yet highly personalized treatment. Grip self-help thus has the potential to meet the needs of the large group of patients with mild to moderate FSS.

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Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

Cited by 18 publications

References 30 publications

How general practitioners understand and handle medically unexplained symptoms: a focus group study

How general practitioners understand and handle medically unexplained symptoms: a focus group study

Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database

Development of Grip self-help: An online patient-tailored self-help intervention for functional somatic symptoms in primary care

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