title: Why do general practitioners decline training to improve management of medically unexplained symptoms?
abstract: BACKGROUND
  General practitioners' (GPs) communication with patients presenting medically unexplained symptoms (MUS) has the potential to somatize patients' problems and intensify dependence on medical care. Several reports indicate that GPs have negative attitudes about patients with MUS. If these attitudes deter participation in training or other methods to improve communication, practitioners who most need help will not receive it.
  
  
  OBJECTIVE
  To identify how GPs' attitudes to patients with MUS might inhibit their participation with training to improve management.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  GPs (N = 33) who had declined or accepted training in reattribution techniques in the context of a research trial.
  
  
  METHODS
  GPs were interviewed and their accounts analysed qualitatively.
  
  
  RESULTS
  Although attitudes that devalued patients with MUS were common in practitioners who had declined training, these coexisted, in the same practitioners, with evidence of intuitive and elaborate psychological work with these patients. However, these practitioners devalued their psychological skills. GPs who had accepted training also described working psychologically with MUS but devalued neither patients with MUS nor their own psychological skills.
  
  
  CONCLUSIONS
  GPs' attitudes that suggested disengagement from patients with MUS belied their pursuit of psychological objectives. We therefore suggest that, whereas negative attitudes to patients have previously been regarded as the main barrier to involvement in measures to improve patient management, GPs devaluing of their own psychological skills with these patients may be more important.
authors: Division of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool, UK. psalmon@liv.ac.uk
authors: Peter
authors: P
authors: Salmon
authors: Sarah
authors: S
authors: Peters
authors: Rebecca
authors: R
authors: Clifford
authors: Wendy
authors: W
authors: Iredale
authors: Linda
authors: L
authors: Gask
authors: Anne
authors: A
authors: Rogers
authors: Christopher
authors: C
authors: Dowrick
authors: John
authors: J
authors: Hughes
authors: Richard
authors: R
authors: Morriss
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000379:methods; D005194:Family Practice / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education* / Q000523:psychology; D013001:Somatoform Disorders / Q000628:therapy*