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BioPsychoSocial Medicine

, 2:22

First Online: 17 November 2008Received: 27 June 2008Accepted: 17 November 2008


BackgroundPhysicians in primary and secondary care are frequently confronted with patients with medically unexplained symptoms MUS. In order to solve their patients- problems and out of a fear of overlooking a serious disease, many physicians give their patients full physical examinations and interventions, thereby incorrectly confirming the somatic nature of their condition. Preventing somatization could be achieved by examining the patient-s symptom presentation for clues to underlying psychosocial issues and by an appropriate physician response.

MethodsNinety-seven videotaped medical visits from primary care patients presenting MUS for the first time were analyzed. Patients- presentations were categorized in: 1 symptoms only; 2 symptoms with a clue to an underlying concern; or 3 symptoms with an explicit concern. General practitioners- GPs- responses to patients- presentation were classified into ignoring or more or less exploring responses. Exploring responses were further subdivided in non-directional explorations, clue explorations and medical explorations.

ResultsResults show that most patients presented their symptoms together with a reference to an underlying concern. Yet, most of them did so in an implicit way. GPs usually explored the concern presented by the patients, but most often in a medical way only.

ConclusionTo address the potential psychological basis of patients- medically unexplained symptoms, GPs should pay more attention to the specific clues patients present to them. Likewise, in order to receive full attention, patients should try to present their concerns more explicitly.

Electronic supplementary materialThe online version of this article doi:10.1186-1751-0759-2-22 contains supplementary material, which is available to authorized users.

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Autor: Teus Kappen - Sandra van Dulmen


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