title: What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms.
abstract: BACKGROUND
  Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health.
  
  
  OBJECTIVE
  To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general.
  
  
  METHODS
  Thematic analysis of in-depth interviews.
  
  
  RESULTS
  Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.
  
  
  CONCLUSIONS
  Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK. Sarah.peters@manchester.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Peter
authors.initials: P
authors.lastname: Salmon
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Chris
authors.initials: C
authors.lastname: Dowrick
authors.forename: Maria
authors.initials: M
authors.lastname: Towey
authors.forename: Rebecca
authors.initials: R
authors.lastname: Clifford
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003144:Communication Barriers; D003933:Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family