title: Community physicians' strategies for patients with medically unexplained symptoms.
abstract: OBJECTIVE
  This qualitative study examined the management strategies that community primary care physicians use for patients with medically unexplained symptoms (MUS).
  
  
  METHODS
  Volunteer community physicians identified patients with chronic MUS. The physicians and patients were interviewed separately about management strategies used and their effectiveness. Thematic analyses were used to categorize these strategies.
  
  
  RESULTS
  Thirty-six physicians and 49 of their patients completed interviews. Physician strategies considered effective by physicians and patients included medical treatment, exploring causes of symptoms with tests and referrals, attentive listening, validating complaints, demonstrating commitment over time (eg, assuring patients of continued care, allowing extended office visits, and returning phone calls), providing clear explanations of symptoms and management, and providing explanatory models for the linkage between psychosocial factors and physical symptoms. Strategies used that conflict with published recommendations included ordering potentially unnecessary diagnostic tests, scheduling patients on demand, and prescribing narcotics. Physicians expressed concerns about these strategies but considered the benefits for specific patients worth the costs and risks.
  
  
  CONCLUSIONS
  Physicians used some strategies recommended in the medical literature and others not recommended. The ability to effectively implement certain strategies may depend on having a long-term relationship with a patient and a health care environment that permits extensive patient-physician interaction.
authors.affiliation: Department of Internal Medicine, University of Iowa, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Anderson
authors.forename: Arthur
authors.initials: A
authors.lastname: Hartz
authors.forename: Terri
authors.initials: T
authors.lastname: Nordin
authors.forename: Marcy
authors.initials: M
authors.lastname: Rosenbaum
authors.forename: Russell
authors.initials: R
authors.lastname: Noyes
authors.forename: Paul
authors.initials: P
authors.lastname: James
authors.forename: John
authors.initials: J
authors.lastname: Ely
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.forename: Steve
authors.initials: S
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D019937:Diagnostic Techniques and Procedures; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000628:therapy*