title: How patients and family physicians communicate about persistent medically unexplained symptoms. A qualitative study of video-recorded consultations.
abstract: OBJECTIVE
  To study doctor-patient interaction styles in consultations with patients presenting persistent medically unexplained symptoms (MUS) and to study on which stages of the consultation patients and doctors focus within the available time.
  
  
  METHODS
  exploratory, qualitative analysis of transcripts of 20 videotaped consultations between family physicians (FP) and persistent MUS patients.
  
  
  RESULTS
  Patients presented many symptoms in a rather unstructured way. However, FPs hardly used structuring techniques such as agenda setting and summarizing. Patients with persistent MUS got much opportunity to tell their story, but the reasons for encounter, their beliefs and concerns were not discussed in a structured manner. Although consultations were focused on these issues, mostly patients themselves initiated discussion of their ideas, concerns and expectations. FPs' extensive explanations of the origin of the symptoms often did not take patients' beliefs and concerns into account.
  
  
  CONCLUSIONS
  Due to patients' multiple symptom presentation and the absence of FPs' structuring techniques, consultations of persistent MUS patients proceed rather unfocused. However, patients got ample opportunity to tell their story.
  
  
  CONCLUSIONS
  Persistent MUS patients might benefit from structured consultations focused on the exploration of the reason for encounter.
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. t.oldehartman@elg.umcn.nl
authors.forename: Tim C
authors.initials: TC
authors.lastname: olde Hartman
authors.forename: Eric
authors.initials: E
authors.lastname: van Rijswijk
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Evelyn
authors.initials: E
authors.lastname: van Weel-Baumgarten
authors.forename: Peter L B J
authors.initials: PL
authors.lastname: Lucassen
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003144:Communication Barriers; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012017:Referral and Consultation / Q000592:standards*; D013001:Somatoform Disorders / Q000175:diagnosis; D014743:Videotape Recording