BMJ 1999;318:372-376 ( 6 February )

General Practice

Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis

Peter Salmon, professor, a Sarah Peters, research assistant, a Ian Stanley, emeritus professor. b

a Department of Clinical Psychology, University of Liverpool, Liverpool L69 3GB, b Department of Primary Care, University of Liverpool, Liverpool L69 3GB

Correspondence to: Professor Stanley

Objectives: To describe, from the perspective of patients, distinguishing features of doctors' attempts to explain the symptoms of somatisation disorders.
Design: Qualitative analysis of verbatim records of interviews in which patients recounted doctors' explanations of their symptoms.
Setting: Patients with persistent somatising symptoms referred from general practices in Liverpool and St Helens and Knowsley were interviewed before entry into a treatment programme.
Subjects: 228 of 324 patients referred were interviewed. Initial interviews were used to develop the process and technique, and the final analysis was based on a subsample of 68 records, randomly chosen from the transcripts of 188 subjects who were interviewed subsequently.
Results: Doctors' explanations were often at odds with the patients' own thinking. Analysis showed that medical explanations could be grouped into one of three categories, defined by the patients' perceptions. Most explanations were experienced as rejecting the reality of the symptoms. An intermediate category comprised explanations that were viewed as colluding, in which the doctor acquiesced with the patients' own biomedical theories. However, a few explanations were perceived by patients as tangible, exculpating, and involving. These explanations were experienced by patients as satisfying and empowering.
Conclusions: Patients with somatisation disorders feel satisfied and empowered by medical explanations that are tangible, exculpating, and involving. Empowering explanations could improve these patients' wellbeing and help to reduce the high demands they make on health services.


Key messages

  • Patients with somatisation disorders make disproportionately heavy demands on health services

  • Doctors' explanations of their symptoms are often at odds with these patients' own thinking

  • Patients with somatisation disorders describe three types of medical explanation---rejecting, colluding, and empowering

  • Empowering explanations are tangible, exculpating, and involve patients in managing their illness

  • Patients' reactions to empowering explanations suggest that these have the potential to reduce demand for health care




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