Physicians’ Responses to Patients’ Medically Unexplained Symptoms
| Autor: | Patricia A. Carney, Paul R. Duberstein, Cleveland G. Shields, Sean Meldrum, Jennifer K. Carroll, Kevin Fiscella, Ronald M. Epstein |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Self Disclosure Population Psychological intervention Context (language use) Trust Chest pain Informed consent medicine Humans Medical History Taking Somatoform Disorders education Applied Psychology Physician-Patient Relations education.field_of_study Primary Health Care business.industry medicine.disease Patient Simulation Psychiatry and Mental health Family medicine GERD Female medicine.symptom business Psychosocial Somatization |
| Zdroj: | Psychosomatic Medicine. 68:269-276 |
| ISSN: | 0033-3174 |
| DOI: | 10.1097/01.psy.0000204652.27246.5b |
| Popis: | Objective To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). Methods After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3). Results In multivariate analyses, MUS visits yielded significantly lower scores on MPCC component 1 (p = .01). Subanalysis of component 1 scores showed that patients' symptoms were not explored as fully and that validation was less likely to be used in response to patient concerns in the MUS than in the GERD visits. Component 2 and component 3 were unchanged. Conclusion Physicians' inquiry into and validation of symptoms in patients with MUS was less common compared with more medically straightforward patient presentations. Further research should study the relationship between communication variables and poor clinical outcomes, misunderstandings, mutual distrust, and inappropriate healthcare utilization in this population, and test interventions to address this problem. |
| Databáze: | OpenAIRE |
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