title: Multiple somatic symptoms in primary care patients: a cross-sectional study of consultation content, clinical management strategy and burden of encounter.
abstract: Consultations involving patients with multiple somatic symptoms may be considered as challenging and time-consuming by general practitioners (GPs). Yet, little is known about the possible links between consultation characteristics and GP-experienced burden of encounter. We aimed to explore consultation content, clinical management strategies, time consumption and GP-experienced burden of encounters with patients suffering from multiple somatic symptoms as defined by the concept of bodily distress syndrome (BDS).
  
  
  
  Cross-sectional study of patient encounters in primary care from December 2008 to December 2009; 387 GPs participated (response rate: 44.4 %). Data were based on a one-page registration form completed by the GP and a patient questionnaire including the 25-item BDS checklist for somatic symptoms. Using logistic regression analyses, we compared patients who met the BDS criteria with patients who did not.
  
  
  
  A total of 1505 patients were included (response rate: 55.6 %). Health problems were less frequently reported as 'new' in patients with BDS (odds ratio (OR) = 0.73, 95 % confidence interval (CI): 0.54; 0.97). Medical prescriptions and referral rates were comparable in the two patient groups. Consultations focusing on mainly biomedical aspects were less frequent among patients with BDS (OR = 0.31, 95 % CI: 0.22; 0.43), whereas additional biomedical and psychosocial problems were more often discussed. GPs were more likely to ensure continuity of care in BDS patients by watchful waiting strategies (OR = 2.32, 95 % CI: 1.53; 3.52) or scheduled follow-up visits (OR = 1.61, 95 % CI: 1.09; 2.37). Patients with BDS were found to be more time-consuming (OR = 1.77, 95 % CI: 1.26; 2.48) and burdensome (OR = 2.54, 95 % CI: 1.81; 3.55) than patients without BDS. However, after adjustments for biomedical and psychosocial content of the consultation, the identified differences for time consumption and burden were no longer statistically significant.
  
  
  
  Patients with BDS represent higher care complexity in terms of biomedical and psychosocial needs. GPs seem to allow space and time for discussing these issues and to aim at ensuring continuity in care through watchful waiting or scheduled follow-up consultations. However, the reported GP-experienced burden call for professional development.
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. merask@rm.dk.
authors.forename: Mette T
authors.initials: MT
authors.lastname: Rask
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
authors.forename: Anders H
authors.initials: AH
authors.lastname: Carlsen
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
authors.forename: Anna
authors.initials: A
authors.lastname: Budtz-Lilly
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosendal
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D011307:Drug Prescriptions; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D009819:Office Visits; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013577:Syndrome; D013997:Time Factors; D057832:Watchful Waiting; D016526:Workload; D055815:Young Adult
keywords: Difficult patient encounters; General practice; Medically unexplained symptoms; Referral and consultation; Signs and symptoms; Somatoform disorders