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General practitioners' responses to the initial presentation of medically unexplained symptoms: a quantitative analysis

机译：全科医生对医学上无法解释的症状的初步表现的反应：定量分析

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Background Physicians 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. Methods Ninety-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. Results Results 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. Conclusion To 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.
机译：背景初级保健和二级保健中的医师经常会遇到具有医学上无法解释的症状（MUS）的患者。为了解决患者的问题，并且出于避免忽视严重疾病的担心，许多医生对患者进行了全面的身体检查和干预，从而错误地确定了他们的身体状况。预防躯体化可以通过检查患者的症状表现以了解潜在的心理社会问题的线索以及适当的医生反应来实现。方法分析首次出现MUS的基层医疗患者的97例录像。患者的表现分类为：（1）仅症状; （2）具有潜在隐患的症状;或（3）明确关注的症状。全科医生（GPs）对患者表现的反应分为无视或多或少的探索反应。探索性反应进一步细分为非定向性探索，线索性探索和医学探索。结果结果表明，大多数患者均表现出症状并提及了潜在的担忧。但是，大多数人都是以隐性方式这样做的。全科医生通常会探讨患者提出的问题，但大多数情况下只是以医学方式进行。结论为了解决患者无法解释的症状的潜在心理基础，全科医生应更加注意患者呈现给他们的具体线索。同样，为了引起充分关注，患者应尝试更明确地表达自己的担忧。

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