title: Training specialists to write appropriate reply letters to general practitioners about patients with medically unexplained physical symptoms; A cluster-randomized trial.
abstract: OBJECTIVE
  To evaluate effects of a communication training for specialists on the quality of their reply letters to general practitioners (GPs) about patients with medically unexplained physical symptoms (MUPS).
  
  
  METHODS
  Before randomization, specialists included ≤3 MUPS patients in a multi-center cluster-randomized trial. In 14h of MUPS-specific communication training, 2.5h focused on reply letters. Letters were discussed with regard to reporting and answering GPs' referral questions and patients' questions, and to reporting findings, explaining MUPS with perpetuating factors and giving advice. After the training, all doctors again included ≤3 MUPS patients. Reply letters to GPs were assessed for quality and blindly rated on a digital scale.
  
  
  RESULTS
  We recruited 478 MUPS patients and 123 specialists; 80% of the doctors wrote ≥1 reply letters, 285 letters were assessed. Trained doctors reported (61% versus 37%, OR=2.55, F(1281)=6.60, p(group*time)=.01) and answered (63% versus 33%, OR=3.31, F(1281)=5.36, p(group*time)=.02) patients' questions more frequently than untrained doctors.
  
  
  CONCLUSIONS
  Training improves reply letters with regard to patients' questions, but not with regard to the following: GPs' referral questions, somatic findings, additional testing, explaining, and advice.
  
  
  CONCLUSIONS
  Training specialists to write appropriate reply letters needs more focus on explanation and advice.
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, The Netherlands. Electronic address: info@anneweiland.nl.
authors.forename: Anne
authors.initials: A
authors.lastname: Weiland
authors.affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Annette H
authors.initials: AH
authors.lastname: Blankenstein
authors.affiliation: Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Mariëtte H A
authors.initials: MH
authors.lastname: Willems
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan L C M
authors.initials: JL
authors.lastname: Van Saase
authors.affiliation: Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Paul L A
authors.initials: PL
authors.lastname: Van Daele
authors.affiliation: Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, The Netherlands.
authors.forename: Henk T
authors.initials: HT
authors.lastname: Van der Molen
authors.affiliation: Faculty of Medicine, Amsterdam Medical Center, University Hospital Amsterdam, The Netherlands.
authors.forename: Ginger B
authors.initials: GB
authors.lastname: Langbroek
authors.affiliation: Department of Internal Medicine, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Aart
authors.initials: A
authors.lastname: Bootsma
authors.affiliation: Department of Neurology, Diakonessenhuis Utrecht, The Netherlands.
authors.forename: Els M
authors.initials: EM
authors.lastname: Vriens
authors.affiliation: Department of Gastroenterology, Diakonessenhuis Utrecht, The Netherlands.
authors.forename: Ardi
authors.initials: A
authors.lastname: Oberndorff-Klein Woolthuis
authors.affiliation: Clinical Trial Center, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: René M
authors.initials: RM
authors.lastname: Vernhout
authors.affiliation: Faculty of Social Sciences, Institute of Psychology, Erasmus University Rotterdam, The Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Faculty of Social Sciences, Institute of Pedagogical Sciences, Erasmus University Rotterdam, The Netherlands.
authors.forename: Lidia R
authors.initials: LR
authors.lastname: Arends
mesh_terms: D000328:Adult; D003142:Communication; D003266:Continuity of Patient Care; D015709:Correspondence as Topic; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D058005:General Practitioners / Q000193:education* / Q000523:psychology; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D013001:Somatoform Disorders / Q000523:psychology / Q000628:therapy; D014956:Writing
keywords: Cluster-randomized trial; Doctor-patient communication; Medical specialist; Medically unexplained physical symptoms; Patient-centered care; Physician-patient relationship; Post-graduate medical education; general practice; reply letter