Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study

doi:10.1136/bmj.38057.622639.EE

BMJ 2004;328:1057 (1 May), doi:10.1136/bmj.38057.622639.EE (published 31 March 2004)

Primary care

Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study

Adele Ring, research assistant¹, Christopher Dowrick, professor of primary medical care², Gerry Humphris, professor of health psychology³, Peter Salmon, professor of clinical psychology¹

¹ Department of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, ² Department of Primary Care, University of Liverpool, Liverpool L69 3GB, ³ Bute Medical School, University of St Andrews, St Andrews KY16 9ST

Correspondence to: P Salmon psalmon{at}liv.ac.uk

Objectives To identify the ways in which patients with medicallyunexplained symptoms present their problems and needs to generalpractitioners and to identify the forms of presentation thatmight lead general practitioners to feel pressurised to deliversomatic interventions.

Design Qualitative analysis of audiorecorded consultations betweenpatients and general practitioners.

Setting 7 general practices in Merseyside, England.

Participants 36 patients selected consecutively from 21 generalpractices, in whom doctors considered that patients' symptomswere medically unexplained.

Main outcome measures Inductive qualitative analysis of waysin which patients presented their symptoms to general practitioners.

Results Although 34 patients received somatic interventions(27 received drug prescriptions, 12 underwent investigations,and four were referred), only 10 requested them. However, patientspresented in other ways that had the potential to pressurisegeneral practitioners, including: graphic and emotional language;complex patterns of symptoms that resisted explanation; descriptionof emotional and social effects of symptoms; reference to otherindividuals as authority for the severity of symptoms; and biomedicalexplanations.

Conclusions Most patients with unexplained symptoms receivedsomatic interventions from their general practitioners but hadnot requested them. Though such patients apparently seek toengage the general practitioner by conveying the reality oftheir suffering, general practitioners respond symptomatically.

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Rapid Responses:

Read all Rapid Responses

ARE YOU A BIT NAIVE?: graeme mackenzie
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Join me at the coal face: John Hopkins
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Psychological dissection of unexplained physical symptoms!: Dr. Naseem A. Qureshi
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Richard Smith - not qualified to comment: david baker
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Sorting the wheat from the chaff: Trefor J Roscoe
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Re: Sorting the wheat from the chaff: Lisa C Blakemore-Brown
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Re: Re: Sorting the wheat from the chaff: Ellen Goudsmit
bmj.com, 4 May 2004 [Full text]
Re: Re: Sorting the wheat from the chaff: Gurli Bagnall
bmj.com, 17 May 2004 [Full text]
Study GPs let down by authors and editor: Graham Wheatley
bmj.com, 5 May 2004 [Full text]
It's not just patients who make things up: Jenny L Robertson, et al.
bmj.com, 10 May 2004 [Full text]
Treatments unexplained, why not symptoms: Joan T McClusky
bmj.com, 6 May 2004 [Full text]
Second opinion: Phillip J. Colquitt
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Second opinions prevented in this draconian system: Lisa C Blakemore-Brown
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Re: Study GPs let down by authors and editor: Mark Struthers
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Re: Study GPs let down by authors and editor: Graham Wheatley
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Medically Unexplained - so blame the patient.: Charles Pragnell
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Unexplained Symptoms Require Appropriate Investigation: Michael D Innis
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The Freudian Fallacy (or the need to be cautious about diagnosis): susanne McCabe
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Point of information: Sharon Davies
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