Salmon Peter, Humphris Gerry M, Ring Adele, Davies John C, Dowrick Christopher F
Department of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, UK.
Psychosom Med. 2007 Jul-Aug;69(6):571-7. doi: 10.1097/PSY.0b013e3180cabc85. Epub 2007 Jul 16.
In primary care, many consultations about physical symptoms that the doctor thinks are not explained by physical disease nevertheless lead to somatic interventions. Our objective was to test the predictions that somatic intervention becomes more likely a) when doctors provide simple reassurance rather than detailed symptom explanations and do not help patients discuss psychosocial problems and b) when patients try to engage doctors by extending their symptom presentation.
Consultations of 420 patients presenting physical symptoms that the doctor considered unexplained by physical disease were audio-recorded, transcribed, and coded. Analysis modeled the probability of somatic intervention as a function of the quantity of specific types of speech by patients (symptomatic and psychosocial presentations) and doctors (normalization, physical explanations, psychosocial discussion).
Somatic intervention was associated with the duration of consultation. Controlling for duration, it was, as predicted, associated positively with symptom presentations and inversely with patients' and doctors' psychosocial talk. The relationship with doctors' psychosocial talk was accounted for by patients' psychosocial talk. Contrary to predictions, doctors' normalization was inversely associated with somatic intervention and physical explanations had no effect.
Somatic intervention did not result from the demands of patients. Instead, it became more likely as patients complained about their symptoms. Facilitating patients' psychosocial talk has the potential to divert consultations about medically unexplained symptoms from somatic interventions. To understand why such consultations often lead to somatic interventions, we must understand why patients progressively extend their symptom presentations and why doctors, in turn, apparently respond to this by providing somatic intervention.
在初级保健中，许多关于身体症状的会诊，尽管医生认为无法用身体疾病来解释，但最终还是导致了躯体干预。我们的目的是检验以下预测：a）当医生提供简单的安慰而非详细的症状解释，且不帮助患者讨论心理社会问题时；b）当患者通过延长症状表述来试图吸引医生时，躯体干预更有可能发生。
对420名出现身体症状且医生认为无法用身体疾病解释的患者的会诊进行录音、转录和编码。分析将躯体干预的概率建模为患者（症状性和心理社会表述）和医生（正常化、身体解释、心理社会讨论）特定类型言语量的函数。
躯体干预与会诊时长相关。在控制时长的情况下，正如预测的那样，它与症状表述呈正相关，与患者和医生的心理社会交谈呈负相关。与医生心理社会交谈的关系是由患者的心理社会交谈所导致的。与预测相反，医生的正常化与躯体干预呈负相关，而身体解释没有影响。
躯体干预并非源于患者的需求。相反，则是随着患者抱怨其症状而更有可能发生。促进患者的心理社会交谈有可能将会诊从针对无法用医学解释的症状的躯体干预中转移出来。为了理解为何此类会诊常常导致躯体干预，我们必须理解为何患者会逐渐延长其症状表述，以及医生为何反过来显然会通过提供躯体干预对此作出回应。
