Family Doctor Department, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.
Fam Pract. 2012 Apr;29(2):228-34. doi: 10.1093/fampra/cmr065. Epub 2011 Sep 1.
Patients with medically unexplained symptoms (MUS) are highly prevalent in primary care. There are no guidelines for treatment and management of this group of patients in the Polish health care system and the establishment of a long-term doctor-patient relationship, which is the crux of the therapy, is impeded.
To establish what challenges Polish GPs encounter while dealing with patients with MUS.
A thematic analysis of 4 focus groups (14 GPs altogether), using a three-level coding of data.
Three main themes surfaced in the analysis: negative emotions among the investigated GPs, their insufficient training in the management of patients with MUS and the lack of guidelines and the influence of the changed health care environment on the management of patients with MUS. Four major influences of the changed health care environment emerged: GPs' negative image as professionals, barriers to building a continuous doctor-patient relationship, limited resources and limited access to specialists and lack of a multidisciplinary primary care team.
Treatment and management of patients with MUS should make provision for a personalized approach to the patient within the Polish primary health care system. This can be enhanced by providing additional training in the biopsychosocial model during medical education and establishing a GP multidisciplinary team. Allocating increased financial resources for primary health care and facilitating access to psychologists and psychotherapists could also prove beneficial.
在初级保健中，患有医学无法解释症状（MUS）的患者极为普遍。波兰的医疗保健系统中没有针对这组患者的治疗和管理指南，阻碍了建立长期医患关系，而这正是治疗的关键。
确定波兰全科医生在处理 MUS 患者时遇到的挑战。
使用数据三级编码对 4 个焦点小组（共 14 名全科医生）进行主题分析。
分析中出现了三个主要主题：调查的全科医生中存在负面情绪、他们在管理 MUS 患者方面的培训不足以及缺乏指南和医疗保健环境变化对 MUS 患者管理的影响。医疗保健环境变化的四个主要影响因素包括：医生负面形象、建立连续医患关系的障碍、资源有限以及获得专家的机会有限，以及缺乏多学科初级保健团队。
在波兰初级卫生保健系统中，应针对患者的个人情况为治疗和管理 MUS 患者提供个性化的方法。可以通过在医学教育中提供生物心理社会模式的额外培训以及建立全科医生多学科团队来加强这一点。增加对初级保健的财政资源分配，并促进获得心理学家和心理治疗师的机会，也可能会带来好处。
