title: Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and registrars in general practice.
abstract: BACKGROUND
  Patients with medically unexplained symptoms (MUS) commonly present in general practice. They often experience significant disability and have difficulty accessing appropriate care. Many feel frustrated and helpless. Doctors also describe feeling frustrated and helpless when managing these patients. These shared negative feelings can have a detrimental effect on the therapeutic relationship and on clinical outcomes. The aim of this study was to explore how novice and experienced GPs manage patients with MUS and how these skills are taught and learned in GP training.
  
  
  METHODS
  A constructivist grounded theory study with 24 general practice registrars and supervisors in GP training practices across Australia.
  
  
  RESULTS
  Registrars lacked a framework for managing patients with MUS. Some described negative feelings towards patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the practical, interpersonal and therapeutic challenges associated with the care of these patients.
  
  
  CONCLUSIONS
  Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness, are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings so that consultations are more effective. The care of these patients also raises issues of professional identity, roles and responsibilities. Supervisors can assist their registrars by proactively sharing models of the consultation, strategies for managing their own feelings and frustrations, and ways of understanding and managing the therapeutic relationship in this difficult area of practice.
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney, Level 1 Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW, 2041, Australia. dr.louise.stone@gmail.com.|Academic Unit of General Practice, Australian National University Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra ACT, 0200, Australia. dr.louise.stone@gmail.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Stone
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D011582:Psychological Theory; D036301:Qualitative Research; D012017:Referral and Consultation; D013001:Somatoform Disorders; D055815:Young Adult