Empirically identified goals for the management of unexplained symptoms.
OBJECTIVE
Effective management of patients with medically unexplained symptoms may be influenced by physicians' goals. This study's objective was to identify physicians' goals for managing primary care patients with unexplained symptoms.


METHODS
This was a qualitative study of patients and clinicians from primary care clinics in Iowa and Illinois. Interviews were conducted with 47 patients who had unexplained symptoms and the 36 primary care clinicians who managed them. The interviews were transcribed and coded independently by two investigators. Categories for coding responses were derived from the data and the literature.


RESULTS
Eleven goals were identified and grouped into four classes based on whether they were disease centered, patient centered, society centered, or clinician centered. The three goals most commonly held by patients were patient centered: clinician support (62%), functional improvement (45%), and patient coping (43%). The most common clinician goals were symptom alleviation (38%), patient coping (32%), and functional improvement (30%). Only one clinician (2%) cited making the patient feel supported as a goal.


CONCLUSIONS
The goals of clinician support and patient coping appear to have value to patients beyond being means for achieving symptom alleviation. Although receiving physician support is an important goal for patients, it was not a commonly recognized goal by physicians. Clearly identified management goals may improve the care of patients with medically unexplained symptoms and help clinicians achieve greater satisfaction with the management of these patients.
Nordin
Terri A
TA
Department of Family Medicine, University of Iowa, Iowa City, 52242-1097, USA.
Hartz
Arthur J
AJ
Noyes
Russell
R
Anderson
Matthew C
MC
Rosenbaum
Marcy E
ME
James
Paul A
PA
Ely
John W
JW
Agarwal
Neeraj
N
Levy
Barcey T
BT
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D007484:Iowa; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*