Salmon Peter
Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.
Patient Educ Couns. 2007 Aug;67(3):246-54. doi: 10.1016/j.pec.2007.03.008. Epub 2007 Apr 10.
To identify the basis of the communication problems that characterise consultations about medically unexplained symptoms (MUS) and to identify implications for clinical education.
Recent research into the details of clinical communication about MUS was reviewed narratively and critically, and broader research literature was scrutinised from the perspective of a practitioner who wishes to provide patients with explanations for such symptoms.
Consultations about MUS often involve contest between patients' authority, resting on their knowledge of their symptoms, and practitioners' authority, based on the normal findings of tests and investigations. The outcome of consultations can therefore depend on the strategies that each party uses to press their authority, rather than on clinical need.
Contest is a product of patients and practitioners occupying separate conceptual 'ground'. Avoiding contest requires the practitioner to find common conceptual ground within which each party can understand and discuss the symptoms. Finding common ground by collusion with explanations that patients suggest can damage clinical relationships. Instead the practitioner needs to fashion explanation that is acceptable to both parties from available medical and lay material.
Although practitioners commonly fashion such explanations, this aspect of their professional role seems not to be greatly valued amongst practitioners or in medical curricula. Clinical education programmes could include curricula in symptom explanation, drawing from research in medicine, psychology and anthropology.
确定那些构成关于医学无法解释症状（MUS）会诊特征的沟通问题的根源，并确定其对临床教育的启示。
对近期关于MUS临床沟通细节的研究进行叙述性和批判性综述，并从希望为患者解释此类症状的从业者角度审视更广泛的研究文献。
关于MUS的会诊常常涉及基于患者对自身症状的了解所形成的患者权威与基于检查和检验的正常结果所形成的从业者权威之间的较量。因此，会诊的结果可能取决于双方用于强化自身权威的策略，而非临床需求。
较量是患者和从业者处于不同概念“立场”的产物。避免较量要求从业者找到共同的概念基础，使双方都能理解并讨论这些症状。通过迎合患者提出的解释来找到共同基础可能会损害临床关系。相反，从业者需要根据现有的医学和通俗资料构建双方都能接受的解释。
尽管从业者通常会构建此类解释，但他们专业角色的这一方面在从业者中或医学课程中似乎并未得到高度重视。临床教育项目可以纳入症状解释课程，借鉴医学、心理学和人类学的研究成果。
