title: The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: a phenomenological-hermeneutic study.
abstract: BACKGROUND
  Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of learning to live with MUS as narrated by patients in primary health-care settings.
  
  
  METHODS
  A phenomenological-hermeneutic method was used. Narrative interviews were performed with ten patients suffering from MUS aged 24-61 years. Data were analysed in three steps: naive reading, structural analysis, and comprehensive understanding.
  
  
  RESULTS
  The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining insights and moving on, was based on subthemes describing the patients' search for explanations, learning to take care of oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky's theory of sense of coherence and Kelly's personal construct theory. Possibilities and obstacles, on an individual as well as a structural level, for promoting patients' capacity and learning were illuminated.
  
  
  CONCLUSIONS
  Patients suffering from MUS constantly engage in a reflective process involving reasoning about and interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged as a conventional and necessary care activity.
authors.affiliation: Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; eva.liden@gu.se.
authors.forename: Eva
authors.initials: E
authors.lastname: Lidén
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Björk-Brämberg
authors.affiliation: Angered Family Medicine Unit, Angered, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Svensson
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D066297:Hermeneutics; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D033262:Narration; D010684:Philosophy; D011320:Primary Health Care; D011788:Quality of Life; D012648:Self Care; D035501:Uncertainty; D055815:Young Adult
keywords: MUS; person centred care; phenomenological-hermeneutics; primary care