General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study.
BACKGROUND
The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice.


METHODS
A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data.


RESULTS
Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context.


CONCLUSIONS
Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice.
Dowrick
Christopher
C
Division of Primary Care, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool L69 3GB, UK. cfd@liverpool.ac.uk
Gask
Linda
L
Hughes
John G
JG
Charles-Jones
Huw
H
Hogg
Judith A
JA
Peters
Sarah
S
Salmon
Peter
P
Rogers
Anne R
AR
Morriss
Richard K
RK
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019937:Diagnostic Techniques and Procedures; D004502:Education, Medical, Continuing; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000193:education / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000175:diagnosis; D011795:Surveys and Questionnaires