Reframing chaos - A qualitative study of GPs managing patients with medically unexplained symptoms (what about better diagnosis?)

http://www.ncbi.nlm.nih.gov/pubmed/23826606

Aust Fam Physician. 2013 Jul;42(7):501-2.

Reframing chaos - A qualitative study of GPs managing patients with medically unexplained symptoms.

Stone L.

Source

MBBS, BA, MPH, DipRACOG, FRACGP, FACRRM, is a PhD candidate, Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales.

Abstract

BACKGROUND:

Diagnosis brings order, predictability and validation to suffering. Patients with medically unexplained symptoms experience vulnerability and cultural invalidation. Doctors also struggle to manage these patients.

OBJECTIVE:

To explore the strategies general practitioners use to manage patients with mixed emotional and physical symptoms and no diagnosis.

METHODS:

Thematic analysis utilising semi-structured interviews of 24 Australian GPs.

RESULTS:

Validation of the patient as a person involved building a helpful therapeutic alliance. Commitment to the patient, which the GPs described as 'ownership', involved advocacy and support. Holding uncertainty involved managing the need for a disease name. This included harm minimisation, including uncertainty management. Shift to coping involved the challenges of managing ongoing symptoms that had no name, no cure and no predictable outcome.

DISCUSSION:

Managing patients with medically unexplained symptoms involves professional and personal challenges. However, many of the GPs in this study found managing these patients rewarding in the long term.