title: Reframing chaos--a qualitative study of GPs managing patients with medically unexplained symptoms.
abstract: BACKGROUND
  Diagnosis brings order, predictability and validation to suffering. Patients with medically unexplained symptoms experience vulnerability and cultural invalidation. Doctors also struggle to manage these patients.
  
  
  OBJECTIVE
  To explore the strategies general practitioners use to manage patients with mixed emotional and physical symptoms and no diagnosis.
  
  
  METHODS
  Thematic analysis utilising semi-structured interviews of 24 Australian GPs.
  
  
  RESULTS
  Validation of the patient as a person involved building a helpful therapeutic alliance. Commitment to the patient, which the GPs described as 'ownership', involved advocacy and support. Holding uncertainty involved managing the need for a disease name. This included harm minimisation, including uncertainty management. Shift to coping involved the challenges of managing ongoing symptoms that had no name, no cure and no predictable outcome.
  
  
  CONCLUSIONS
  Managing patients with medically unexplained symptoms involves professional and personal challenges. However, many of the GPs in this study found managing these patients rewarding in the long term.
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales, Australia. louise.stone@gpet.com.au
authors.forename: Louise
authors.initials: L
authors.lastname: Stone
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult