Community physicians' strategies for patients with medically unexplained symptoms

Matt Anderson; Arthur Hartz; Terri Nordin; Marcy Rosenbaum; Russell Noyes; Paul James; John Ely; Neeraj Agarwal; Steve Anderson

Community physicians' strategies for patients with medically unexplained symptoms

Journal article

Peer reviewed

Community physicians' strategies for patients with medically unexplained symptoms

Matt Anderson, Arthur Hartz, Terri Nordin, Marcy Rosenbaum, Russell Noyes, Paul James, John Ely, Neeraj Agarwal and Steve Anderson

Family medicine, Vol.40(2), pp.111-118

02/2008

PMID: 18247177

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Abstract

This qualitative study examined the management strategies that community primary care physicians use for patients with medically unexplained symptoms (MUS). Volunteer community physicians identified patients with chronic MUS. The physicians and patients were interviewed separately about management strategies used and their effectiveness. Thematic analyses were used to categorize these strategies. Thirty-six physicians and 49 of their patients completed interviews. Physician strategies considered effective by physicians and patients included medical treatment, exploring causes of symptoms with tests and referrals, attentive listening, validating complaints, demonstrating commitment over time (eg, assuring patients of continued care, allowing extended office visits, and returning phone calls), providing clear explanations of symptoms and management, and providing explanatory models for the linkage between psychosocial factors and physical symptoms. Strategies used that conflict with published recommendations included ordering potentially unnecessary diagnostic tests, scheduling patients on demand, and prescribing narcotics. Physicians expressed concerns about these strategies but considered the benefits for specific patients worth the costs and risks. Physicians used some strategies recommended in the medical literature and others not recommended. The ability to effectively implement certain strategies may depend on having a long-term relationship with a patient and a health care environment that permits extensive patient-physician interaction.

Attitude of Health Personnel

Somatoform Disorders - therapy

Humans

Middle Aged

Male

Physician-Patient Relations

Physicians, Family

Practice Patterns, Physicians

Diagnostic Techniques and Procedures

Guideline Adherence

Somatoform Disorders - diagnosis

Aged, 80 and over

Adult

Female

Aged

Referral and Consultation

Communication

Practice Guidelines as Topic

Details

Title: Subtitle: Community physicians' strategies for patients with medically unexplained symptoms
Creators: Matt Anderson - Department of Internal Medicine, University of Iowa, USA
Arthur Hartz
Terri Nordin
Marcy Rosenbaum
Russell Noyes
Paul James
John Ely
Neeraj Agarwal
Steve Anderson
Resource Type: Journal article
Publication Details: Family medicine, Vol.40(2), pp.111-118
PMID: 18247177
NLM abbreviation: Fam Med
ISSN: 0742-3225
eISSN: 1938-3800
Publisher: Society of Teachers of Family Medicine; United States
Grant note: 2T32HL07485-21 / NHLBI NIH HHS PD15 PE87007 / BHP HRSA HHS 5D32PE10195-02 / BHP HRSA HHS
Language: English
Date published: 02/2008
Academic Unit: Neurology; Psychiatry; Family and Community Medicine; Office of Consultation and Research in Medical Education
Record Identifier: 9984020854202771

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