BMJ, 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 1, Christopher Dowrick 2, Gerry Humphris 3, Peter Salmon 1

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

Objectives To identify the ways in which patients with medically unexplained symptoms present their problems and needs to general practitioners and to identify the forms of presentation that might lead general practitioners to feel pressurised to deliver somatic interventions.

Design Qualitative analysis of audiorecorded consultations between patients and general practitioners.

Setting 7 general practices in Merseyside, England.

Participants 36 patients selected consecutively from 21 general practices, in whom doctors considered that patients' symptoms were medically unexplained.

Main outcome measures Inductive qualitative analysis of ways in 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, patients presented in other ways that had the potential to pressurise general practitioners, including: graphic and emotional language; complex patterns of symptoms that resisted explanation; description of emotional and social effects of symptoms; reference to other individuals as authority for the severity of symptoms; and biomedical explanations.

Conclusions Most patients with unexplained symptoms received somatic interventions from their general practitioners but had not requested them. Though such patients apparently seek to engage the general practitioner by conveying the reality of their suffering, general practitioners respond symptomatically.

(Accepted 9 March 2004)
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Rapid Responses:

Read all Rapid Responses

ARE YOU A BIT NAIVE?
graeme mackenzie
bmj.com, 30 Apr 2004 [Full text]
Join me at the coal face
John Hopkins
bmj.com, 30 Apr 2004 [Full text]
Psychological dissection of unexplained physical symptoms!
Dr. Naseem A. Qureshi
bmj.com, 30 Apr 2004 [Full text]
Richard Smith - not qualified to comment
david baker
bmj.com, 1 May 2004 [Full text]
Sorting the wheat from the chaff
Trefor J Roscoe
bmj.com, 1 May 2004 [Full text]
Re: Sorting the wheat from the chaff
Lisa C Blakemore-Brown
bmj.com, 2 May 2004 [Full text]
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
bmj.com, 6 May 2004 [Full text]
Second opinions prevented in this draconian system
Lisa C Blakemore-Brown
bmj.com, 6 May 2004 [Full text]
Re: Study GPs let down by authors and editor
Mark Struthers
bmj.com, 7 May 2004 [Full text]
Re: Study GPs let down by authors and editor
Graham Wheatley
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Medically Unexplained - so blame the patient.
Charles Pragnell
bmj.com, 10 May 2004 [Full text]
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
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