title: Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis.
abstract: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.
  
  
  
  To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.
  
  
  
  Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.
  
  
  
  We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.
  
  
  
  We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, 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, Amsterdam, The Netherlands.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Huisman
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
authors.forename: LaKrista
authors.initials: L
authors.lastname: Morton
authors.affiliation: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands and.
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.affiliation: Department of Methodology and Statistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: Marjan J
authors.initials: MJ
authors.lastname: Westerman
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Burton
mesh_terms: D003142:Communication; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D017008:Negotiating; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000523:psychology*
keywords: Physician-patient relations; communication; primary health care; psychosomatic medicine; qualitative research; somatoform disorders/*diagnosis/aetiology/psychology.