title: Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study.
abstract: Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they recognize specific subgroups of patients with MUPS. Targeting such subgroups might improve treatment outcomes.
  
  
  
  Six focus groups were conducted with in total 29 Dutch FPs. Two researchers independently analysed the data applying the principles of constant comparative analysis in order to detect characteristics to recognize MUPS and to synthesize subgroups.
  
  
  
  FPs take into account various characteristics when recognizing MUPS in their patients. More objective characteristics were multiple MUPS, frequent and long consultations and many referrals. Subjective characteristics were negative feelings towards patients and the feeling that the FP cannot make sense of the patient's story. Experience of the FP, affinity with MUPS, consultation skills, knowledge of the patient's context and the doctor-patient relationship seemed to influence how and to what extent these characteristics play a role. Based on the perceptions of the FPs we were able to distinguish five subgroups of patients according to FPs: 1) the anxious MUPS patient, 2) the unhappy MUPS patient, 3) the passive MUPS patient, 4) the distressed MUPS patient, and 5) the puzzled MUPS patient. These subgroups were not mutually exclusive, but were based on how explicit and predominant certain characteristics were perceived by FPs.
  
  
  
  FPs believe that they can properly identify MUPS in their patients during consultations and five distinct subgroups of patients could be distinguished. If these subgroups can be confirmed in further research, personalized treatment strategies can be developed and tested for their effectiveness.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands. m.denboeft@vumc.nl.
authors.forename: Madelon
authors.initials: M
authors.lastname: den Boeft
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.
authors.forename: Danielle
authors.initials: D
authors.lastname: Huisman
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.|Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.
authors.forename: Henriette E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lucassen
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Olde Hartman
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001007:Anxiety / Q000150:complications; D001291:Attitude of Health Personnel; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006801:Humans; D007389:Internal-External Control; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications; D013997:Time Factors
keywords: Diagnostics; Family medicine; Medically unexplained physical symptoms; Patient profiles; Recognition; Somatisation