Olde Hartman Tim C, Hassink-Franke Lieke J, Lucassen Peter L, van Spaendonck Karel P, van Weel Chris
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
BMC Fam Pract. 2009 Sep 24;10:68. doi: 10.1186/1471-2296-10-68.
Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice.
A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis.
GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin.
GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions.
医学上无法解释的症状（MUS）持续出现给全科医生（GP）带来困扰，并对医患关系造成压力。因此，全科医生面临着与这些患者建立持续且最好是有效的关系的问题。本研究旨在探讨全科医生对于向患者解释MUS以及在日常实践中与这些患者的关系如何随时间演变的看法。
采用定性研究方法，在五个焦点小组中对22名荷兰全科医生进行有目的抽样访谈。根据持续比较分析原则对数据进行分析。
全科医生认识到对MUS诊断进行充分解释的重要性，但常常觉得无法向患者清晰解释。因此，全科医生表示他们试图以非特定方式安抚患者，例如告诉患者没有疾病、使用比喻以及使症状正常化。当患者带着MUS不断复诊时，全科医生报告了维持医患关系的重要性。全科医生描述了三种不同的模式来做到这一点；相互联盟模式的特点是在患者和医生都认可的情况下进行常规护理（如定期体检、定期就诊）；矛盾联盟模式的特点是在医生不认可的情况下进行常规护理；非联盟模式的特点是切断所有因非躯体性症状而进行诊疗的理由。
全科医生在解释症状方面感到困难。全科医生报告称，当患者持续出现MUS时，他们通过常规护理来专注于维持医患关系。在这种护理中，他们在维持良好医患关系和预防不必要干预的意外后果之间精心平衡。
