Reid S, Whooley D, Crayford T, Hotopf M
Academic Department of Psychological Medicine, Guy's King's and St Thomas' School of Medicine and Institute of Psychiatry, London SE5 8AZ, UK.
Fam Pract. 2001 Oct;18(5):519-23. doi: 10.1093/fampra/18.5.519.
Medically unexplained physical symptoms present one of the most common problems in modern medical practice but often prove difficult to manage. The central position of the GP in the care of patients with medically unexplained symptoms has been emphasized repeatedly, but little is known about the attitudes of GPs to this role. Understanding how GPs view these patients may inform the development of effective strategies for management.
Our aim was to survey the attitudes of UK GPs towards medically unexplained symptoms (MUS) and somatization.
A random sample of 400 GPs in the South Thames (West) region were surveyed using a postal questionnaire. Respondents' attitudes toward the cause and management of MUS were recorded.
A total of 284 completed questionnaires were returned (22 returned incomplete), giving an adjusted response rate of 75%. Although it was broadly felt that patients with MUS are difficult to manage, most GPs felt that patients with MUS should be managed in primary care. Providing reassurance, counselling and acting as a 'gatekeeper' to prevent inappropriate investigations were considered important roles for GP management. A majority felt that patients with MUS have personality problems or psychiatric illness. Fewer than half of the respondents felt that there are effective treatments available for somatization.
GPs consider the management of patients with MUS to be an important part of their workload, but there is a perception that effective management strategies are lacking. Psychiatrists need to offer greater support and training for GPs in this area of health care.
医学上无法解释的身体症状是现代医疗实践中最常见的问题之一，但往往难以处理。全科医生（GP）在照顾有医学上无法解释症状的患者方面的核心地位已被反复强调，但对于全科医生对这一角色的态度却知之甚少。了解全科医生如何看待这些患者可能有助于制定有效的管理策略。
我们的目的是调查英国全科医生对医学上无法解释的症状（MUS）和躯体化的态度。
使用邮寄问卷对泰晤士河南部（西部）地区的400名全科医生进行随机抽样调查。记录了受访者对医学上无法解释的症状的病因和管理的态度。
共收回284份完整问卷（22份不完整），调整后的回复率为75%。尽管普遍认为有医学上无法解释的症状的患者难以管理，但大多数全科医生认为有医学上无法解释的症状的患者应在基层医疗中进行管理。提供安慰、咨询并充当“把关人”以防止进行不适当的检查被认为是全科医生管理的重要职责。大多数人认为有医学上无法解释的症状的患者存在人格问题或精神疾病。不到一半的受访者认为有针对躯体化的有效治疗方法。
全科医生认为管理有医学上无法解释的症状的患者是其工作量的重要组成部分，但人们认为缺乏有效的管理策略。精神科医生需要在这一医疗领域为全科医生提供更多支持和培训。
