Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis

Madelon den Boeft; Daniëlle Huisman; LaKrista Morton; Peter Lucassen; Johannes C van der Wouden; Marjan J Westerman; Henriëtte E van der Horst; Christopher D Burton

doi:10.1093/fampra/cmw113

Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis

Madelon den Boeft, Daniëlle Huisman, LaKrista Morton, Peter Lucassen, Johannes C van der Wouden, Marjan J Westerman, Henriëtte E van der Horst, Christopher D Burton

Psychology

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

Abstract

BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.

OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.

METHODS: Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.

RESULTS: We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.

CONCLUSION: We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.

Original language	English
Pages (from-to)	107-113
Number of pages	7
Journal	Family Practice
Volume	34
Issue number	1
Early online date	19 Nov 2016
DOIs	https://doi.org/10.1093/fampra/cmw113
Publication status	Published - Feb 2017

Keywords

Communication
Female
General Practice
Humans
Male
Medically Unexplained Symptoms
Middle Aged
Negotiating
Physician-Patient Relations
Qualitative Research
Somatoform Disorders/psychology

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10.1093/fampra/cmw113

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title = "Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis",

abstract = "BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.METHODS: Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.RESULTS: We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.CONCLUSION: We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.",

keywords = "Communication, Female, General Practice, Humans, Male, Medically Unexplained Symptoms, Middle Aged, Negotiating, Physician-Patient Relations, Qualitative Research, Somatoform Disorders/psychology",

author = "{den Boeft}, Madelon and Dani{\"e}lle Huisman and LaKrista Morton and Peter Lucassen and {van der Wouden}, {Johannes C} and Westerman, {Marjan J} and {van der Horst}, {Henri{\"e}tte E} and Burton, {Christopher D}",

year = "2017",

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doi = "10.1093/fampra/cmw113",

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AU - den Boeft, Madelon

AU - Huisman, Daniëlle

AU - Morton, LaKrista

AU - Lucassen, Peter

AU - van der Wouden, Johannes C

AU - Westerman, Marjan J

AU - van der Horst, Henriëtte E

AU - Burton, Christopher D

PY - 2017/2

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N2 - BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.METHODS: Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.RESULTS: We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.CONCLUSION: We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.

AB - BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.METHODS: Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.RESULTS: We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.CONCLUSION: We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.

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KW - Female

KW - General Practice

KW - Humans

KW - Male

KW - Medically Unexplained Symptoms

KW - Middle Aged

KW - Negotiating

KW - Physician-Patient Relations

KW - Qualitative Research

KW - Somatoform Disorders/psychology

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DO - 10.1093/fampra/cmw113

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SN - 0263-2136

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SP - 107

EP - 113

JO - Family Practice

JF - Family Practice

IS - 1

ER -

Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis

Abstract

Keywords

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