title: "You kind of want to fix it don't you?" Exploring general practice trainees' experiences of managing patients with medically unexplained symptoms.
abstract: BACKGROUND
  Much of a General Practitioner's (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees' clinical and educational experiences of managing people presenting with MUS.
  
  
  METHODS
  A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.
  
  
  RESULTS
  Eighty questionnaires out of 120 (67%) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
  
  
  CONCLUSIONS
  Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.
authors.affiliation: Department of Primary Care and Population Health, UCL (Royal Free Campus), Upper Third Floor, Rowland Hill Street, London, NW32PF, UK. m.howman@nhs.net.
authors.forename: Mary
authors.initials: M
authors.lastname: Howman
authors.affiliation: Research Department of Primary Care and Population Health, UCL (Royal Free Campus), Upper Third Floor, Rowland Hill Street, London, NW32PF, UK. k.walters@ucl.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.affiliation: Research Department of Primary Care and Population Health, UCL (Royal Free Campus), Upper Third Floor, Rowland Hill Street, London, NW32PF, UK. j.rosenthal@ucl.ac.uk.
authors.forename: Joe
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Centre for Medical Education, Dundee Medical School, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. r.ajjawi@dundee.ac.uk.
authors.forename: Rola
authors.initials: R
authors.lastname: Ajjawi
authors.affiliation: Research Department of Primary Care and Population Health, UCL (Royal Free Campus), Upper Third Floor, Rowland Hill Street, London, NW32PF, UK. m.buszewicz@ucl.ac.uk.
authors.forename: Marta
authors.initials: M
authors.lastname: Buszewicz
mesh_terms: D001291:Attitude of Health Personnel; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D058005:General Practitioners / Q000193:education / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D035501:Uncertainty
references.citation: Br J Gen Pract. 1999 Apr;49(441):263-7
references.pmid: 10736901
references.citation: Med Educ. 2014 Feb;48(2):189-203
references.pmid: 24528401
references.citation: J Psychosom Res. 2001 Jul;51(1):361-7
references.pmid: 11448704
references.citation: Fam Pract. 2001 Oct;18(5):519-23
references.pmid: 11604375
references.citation: Med Educ. 2002 Mar;36(3):216-24
references.pmid: 11879511
references.citation: Fam Pract. 2002 Apr;19(2):178-82
references.pmid: 11906984
references.citation: Psychosomatics. 2002 Sep-Oct;43(5):394-9
references.pmid: 12297608
references.citation: J Gen Intern Med. 2003 Jun;18(6):478-89
references.pmid: 12823656
references.citation: Br J Gen Pract. 2003 Mar;53(488):231-9
references.pmid: 14694702
references.citation: Br J Gen Pract. 2004 Mar;54(500):165-70
references.pmid: 15006120
references.citation: Science. 1977 Apr 8;196(4286):129-36
references.pmid: 847460
references.citation: Am J Med. 1989 Mar;86(3):262-6
references.pmid: 2919607
references.citation: Int J Psychosom. 1989;36(1-4):86-9
references.pmid: 2599789
references.citation: Ann Intern Med. 1998 Jan 15;128(2):118-26
references.pmid: 9441572
references.citation: Fam Pract. 1998 Apr;15(2):119-25
references.pmid: 9613478
references.citation: Aust N Z J Psychiatry. 1998 Aug;32(4):528-33
references.pmid: 9711367
references.citation: BMJ. 1999 Feb 6;318(7180):372-6
references.pmid: 9933202
references.citation: Fam Pract. 2005 Aug;22(4):419-27
references.pmid: 15897211
references.citation: Arch Gen Psychiatry. 2005 Aug;62(8):903-10
references.pmid: 16061768
references.citation: Acad Psychiatry. 2006 Mar-Apr;30(2):120-5
references.pmid: 16609117
references.citation: J Gen Intern Med. 2006 Jul;21(7):671-7
references.pmid: 16808764
references.citation: Gen Hosp Psychiatry. 2006 Jul-Aug;28(4):343-51
references.pmid: 16814635
references.citation: Br J Psychiatry. 2007 Dec;191:536-42
references.pmid: 18055958
references.citation: Psychother Psychosom Med Psychol. 2008 Aug;58(8):321-5
references.pmid: 18293254
references.citation: BMC Fam Pract. 2008;9:46
references.pmid: 18713473
references.citation: J Gen Intern Med. 2009 Jul;24(7):829-32
references.pmid: 19408058
references.citation: Med Educ. 2009 Jul;43(7):637-44
references.pmid: 19573186
references.citation: Psychother Psychosom. 2010 Jun;79(4):227-37
references.pmid: 20424500
references.citation: Med Teach. 2011;33(2):e92-104
references.pmid: 21275539
references.citation: Fam Pract. 2011 Jun;28(3):300-6
references.pmid: 21177744
references.citation: J Psychosom Res. 2011 Nov;71(5):325-34
references.pmid: 21999976
references.citation: Int J Psychiatry Med. 2011;42(1):1-11
references.pmid: 22372021
references.citation: Med Teach. 2012;34(4):327-9
references.pmid: 22455702
references.citation: Med Teach. 2012;34(7):543-7
references.pmid: 22632276
references.citation: Patient Educ Couns. 2013 May;91(2):249-54
references.pmid: 23369375
references.citation: Philos Ethics Humanit Med. 2013;8:11
references.pmid: 24006875
references.citation: Patient Educ Couns. 2014 Jan;94(1):33-42
references.pmid: 24139540
references.citation: Psychosom Med. 2001 May-Jun;63(3):335-43
references.pmid: 11382261