title: A taxonomy of explanations in a general practitioner clinic for patients with persistent "medically unexplained" physical symptoms.
abstract: To develop a taxonomy of explanations for patients with persistent physical symptoms.
  
  
  
  We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained," physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations.
  
  
  
  We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts - generic statements about normal or dysfunctional processes; Causes - person-specific statements about proximal or distal causes for symptoms; Mechanisms - processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components.
  
  
  
  This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.
  
  
  
  The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.
authors: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: l.morton@abdn.ac.uk.
authors: LaKrista
authors: L
authors: Morton
authors: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: a.m.elliott@abdn.ac.uk.
authors: Alison
authors: A
authors: Elliott
authors: Division of Medical and Dental Education, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: jen.cleland@abdn.ac.uk.
authors: Jennifer
authors: J
authors: Cleland
authors: Department of Psychology, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK. Electronic address: vincent.deary@northumbria.ac.uk.
authors: Vincent
authors: V
authors: Deary
authors: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: c.burton@abdn.ac.uk.
authors: Christopher
authors: C
authors: Burton
mesh_terms: D000554:Ambulatory Care Facilities; D003142:Communication; D005194:Family Practice / Q000379:methods*; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D012017:Referral and Consultation; D013001:Somatoform Disorders / Q000145:classification* / Q000523:psychology; D006113:United Kingdom
keywords: Explanation; Medically unexplained symptoms; Primary care; Reassurance; Somatoform disorders