Patients who present physical symptoms in the absence of physical pathology: a challenge to existing models of doctor-patient interaction.

Many patients seek physical treatment for physical symptoms in the absence of physical pathology and incur symptomatic interventions that are ineffective, costly and iatrogenic. It is therefore important to understand how decisions to provide physical intervention can arise in consultations in the absence of physical pathology. Existing models of doctor-patient communication are ill-suited to understanding these consultations. A series of studies has provided the components of an alternative approach that is based on understanding consultation from the patients' perspective. Specifically, these studies have delineated: sources of patients' perception of their authority over doctors; what patients seek by consulting their doctors; and ways that patients use their authority to influence doctors to provide what they seek. Patients' authority reflects primarily their own sensory and infallible knowledge of symptoms. Their influence derives from descriptions of subjective symptoms and from additional strategies including descriptions of the psychosocial effects of symptoms, catastrophising and requesting treatment. This analysis suggests directions for future research and medical training.