Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?
OBJECTIVE
Consultations about medically unexplained symptoms (MUSs) can resemble contests over the legitimacy of patients' demands. To understand doctors' motivations for speech appearing to be critical of patients with MUSs, we tested predictions that its frequency would be related to patients' demands for emotional support and doctors' patient-centered attitudes as well as adult attachment style.


METHODS
Twenty-four general practitioners identified 249 consecutive patients presenting with MUSs and indicated their own patient-centered attitudes as well as adult attachment style (positive models of self and others). Before consultation, patients self-reported their desire for emotional support. Consultations were audio recorded and coded utterance by utterance. The number of utterances coded as criticism was the response variable in the multilevel regression analyses.


RESULTS
Frequency of criticism was positively related to patients' demands for emotional support, to doctors' belief in sharing responsibility with patients and to doctors' positive model of themselves. It was inversely associated with doctors' belief that patients' feelings were legitimate business for consultation and was unrelated to their model of others.


CONCLUSIONS
From the perspective of doctors, speech that appears to be critical probably reflects therapeutic intent and might therefore be better described as "confrontation." Understanding doctors' motivations for what they say to patients with MUSs will allow for more effective interventions to improve the quality of consultations.
Salmon
Peter
P
Division of Clinical Psychology, University of Liverpool, Brownlow Hill, L69 3GB Liverpool, UK. psalmon@liv.ac.uk
Wissow
Larry
L
Carroll
Janine
J
Ring
Adele
A
Humphris
Gerry M
GM
Davies
John C
JC
Dowrick
Christopher F
CF
D004739:England; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012017:Referral and Consultation; D012944:Social Support; D013222:State Medicine; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013637:Tape Recording