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

BMJ 1999; 318 doi: (Published 06 February 1999) Cite this as: BMJ 1999;318:372
  1. Peter Salmon, professora,
  2. Sarah Peters, research assistanta,
  3. Ian Stanley, emeritus professorb
  1. aDepartment of Clinical Psychology, University of Liverpool, Liverpool L69 3GB
  2. bDepartment of Primary Care, University of Liverpool, Liverpool L69 3GB
  1. Correspondence to: Professor Stanley
  • Accepted 20 October 1998


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.


  • Contributors PS and IS jointly designed, established, and managed the study from which this work arose. PS initiated the analysis of transcripts, and participated in further analysis, interpretation of results, and writing the paper. IS conceived the aim of this paper, participated in the analysis and interpretation of results, and led the writing of the paper. SP recruited patients, conducted the interviews, and contributed to data analysis and to writing the paper. All three authors act as guarantors.

  • Funding Medical Research Council.

  • Competing interest None declared.

  • Accepted 20 October 1998
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