title: The relationship between complaint-related cognitions in referred patients with irritable bowel syndrome and subsequent health care seeking behaviour in primary care.
abstract: BACKGROUND
  It is generally accepted that it is important to explore patients' beliefs and fears about the meaning of their symptoms during medical consultations.
  
  
  OBJECTIVE
  To discover how referral behaviour of GPs and attention to dysfunctional cognitions of medical specialists affect the subsequent health care seeking behaviour of patients with irritable bowel syndrome.
  
  
  METHODS
  Questionnaires were distributed to GPs and to doctors and patients at an outpatient clinic in the University Hospital of Nijmegen.
  
  
  RESULTS
  The results of the present study indicate that doctors' attention to the complaint-related cognitions of IBS-patients is also related to a reduced use of medical health services in primary care. On the other hand, when referred IBS-patients continue to attribute their complaints to a somatic abnormality even after such an abnormality has been ruled out through extensive physical examinations, the subsequent use of medical health services in primary care is likely to increase. Moreover, GPs' referral behaviour appears to strengthen these dysfunctional somatic attributions in IBS-patients.
  
  
  CONCLUSIONS
  These unfavorable consequences might be avoided by handling cognitions and anxiety more specifically during medical consultations in primary as well as secondary care.
authors.affiliation: Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: van Dulmen
authors.forename: J F
authors.initials: JF
authors.lastname: Fennis
authors.forename: H G
authors.initials: HG
authors.lastname: Mokkink
authors.forename: G
authors.initials: G
authors.lastname: Bleijenberg
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D003072:Cognition Disorders / Q000523:psychology*; D003109:Colonic Diseases, Functional / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D010552:Personality Assessment; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation; D012803:Sick Role; D013001:Somatoform Disorders / Q000523:psychology