Somatisation in primary care: clinical judgement and standardised measurement compared.
BACKGROUND
In daily practice general practitioners (GPs) generally rely on their clinical judgement in assessing whether patients somatise distress. Nevertheless, conclusions derived from research on somatisation in primary care are largely based on standardised measurements of somatisation. We investigated the relation between GPs' clinical judgement of somatisation and a somatisation research instrument (DSM-III-R), and examined how both operationalisations of somatisation related to other important variables.


METHODS
In nine general practices, 407 frequently attending patients answered a questionnaire on somatisation symptoms, while the GPs gave their judgement on somatisation and communication for each patient. Other variables were extracted from the registered health status of the patients.


RESULTS
We found a weak association (correlation: 0.27) between the GPs' judgement and the research instrument; however, relations with other variables showed that both operationalisations were very similar constructs. The research instrument incorporated more psychological problems (depression and anxiety), while the GPs' judgement of somatisation was more influenced by attendance rate and by aspects of communication with the patient.


CONCLUSIONS
For research addressing somatisation in primary care as a practical clinical problem, the operationalisation of somatisation should include the clinical judgement of the practitioner as well, thereby widening the focus from co-morbid mental disturbances to communication aspects.
Department of General Practice, University of Maastricht, The Netherlands. Bert.Schilte@hag.unimaas.nl
A F
AF
Schilte
P J
PJ
Portegijs
A H
AH
Blankenstein
J A
JA
Knottnerus
D000328:Adult; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires