title: Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?
abstract: 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.
authors: Division of Clinical Psychology, University of Liverpool, Brownlow Hill, L69 3GB Liverpool, UK. psalmon@liv.ac.uk
authors: Peter
authors: P
authors: Salmon
authors: Larry
authors: L
authors: Wissow
authors: Janine
authors: J
authors: Carroll
authors: Adele
authors: A
authors: Ring
authors: Gerry M
authors: GM
authors: Humphris
authors: John C
authors: JC
authors: Davies
authors: Christopher F
authors: CF
authors: Dowrick
mesh_terms: 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