Normalisation of unexplained symptoms by general practitioners: a functional typology.
BACKGROUND
Patients often present in primary care with physical symptoms that doctors cannot readily explain. The process of reassuring these patients is challenging, complex and poorly understood.


OBJECTIVE
To construct a typology of general practitioners' (GPs') normalising explanations, based on their effect on the process and outcome of consultations involving patients with medically unexplained symptoms.


METHODS
Qualitative analysis of audiotaped consultations between patients and GPs.


METHODS
Seven general practices in Merseyside, United Kingdom.


METHODS
Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively, to identify types of normalising speech used by GPs.


RESULTS
Normalisation without explanation included rudimentary reassurance and the authority of a negative test result. Patients persisted in requesting explanation and elaborated or extended their symptoms, rendering somatic management more likely. Normalisation with ineffective explanation provided a tangible physical explanation for symptoms, unrelated to patient's expressed concerns. This was also counterproductive. Normalisation with effective explanation provided tangible mechanisms grounded in patients' concerns, often linking physical and psychological factors. These explanations were accepted by patients; those linking physical and psychological factors contributed to psychosocial management outcomes.


CONCLUSIONS
The routine exercise of normalisation by GPs contains approaches that are ineffective and may exacerbate patients' presentation. However, it also contains types of explanation that may reduce the need for symptomatic investigation or treatment. These findings can inform the development of well-grounded educational interventions for GPs.
Department of Primary Care, University of Liverpool, Liverpool. cfd@liv.ac.uk
Christopher F
CF
Dowrick
Adele
A
Ring
Gerry M
GM
Humphris
Peter
P
Salmon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D013001:Somatoform Disorders / Q000145:classification* / Q000175:diagnosis / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology