Doctors' attachment style and their inclination to propose somatic interventions for medically unexplained symptoms.
OBJECTIVE
We tested the theory that general practitioners (GPs) offer somatic intervention to patients with medically unexplained symptoms (MUS) as a defensive response to patients' dependence. We predicted that GPs most likely to respond somatically after patients indicated symptomatic or psychosocial needs had attachment style characterised by negative models of self and others.


METHODS
Twenty-five GPs identified 308 patients presenting MUS and indicated their own models of self and others. Consultations were audio recorded and coded speech-turn-by-speech-turn. We modeled the probability of GPs proposing somatic intervention on any turn as a function of their models of self and other and the number of prior turns containing symptomatic or psychosocial presentations.


RESULTS
Prior psychosocial presentations decreased the likelihood of GPs offering somatic intervention. The decrease was greatest in GPs with most positive models of self and, contrary to prediction, least positive models of others. The positive relationship between prior somatic presentations and the likelihood that GPs offered somatic intervention was unrelated to either model.


CONCLUSIONS
Findings are incompatible with our theory that GPs propose somatic interventions defensively. Instead, GPs may provide somatic intervention because they value patients (positive model of others) but devalue their own psychological skills (negative model of self).
Salmon
Peter
P
Division of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, 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
D000328:Adult; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D013001:Somatoform Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires