Hansen Henriette Schou, Rosendal Marianne, Fink Per, Risør Mette Bech
Research Unit for General Practice, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark ; Research Clinic for Functional Disorders, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
Research Unit for General Practice, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark.
ISRN Family Med. 2012 Sep 16;2013:541604. doi: 10.5402/2013/541604. eCollection 2013.
Background. The prevalence of medically unexplained symptoms (MUSs) in primary care is about 10-15%. The definition of MUS is descriptive and there are no specific diagnostic criteria for MUS in primary care. Furthermore, a general practitioner's (GP's) categorisation of patients with MUS shows large variation. The aim of the present study is to investigate how GPs employ the definition of MUS and how they manage patients with MUS in daily practice. Methods. With a grounded theory approach five focus group interviews with GPs were performed. The interviews addressed how GPs managed MUS and their reflections on the course and prognosis for MUS patients. Results. Consultations about MUS develop around the individual patient and usually include several appointments. We identified three different types of consultations: (1) "searching for a disease," (2) "going by the routine," and (3) "following various paths." These types of consultations spanned from a biomedical approach to an approach where multiple explanations were offered to explain the patient's problem. The choice of consultation types was influenced by the GP, the patient and contextual factors which, in turn, affected the diagnostic process. Conclusions. A diagnosis of MUS is contextually embedded and the diagnostic process is shaped by the consultation.
背景。基层医疗中不明原因症状（MUSs）的患病率约为10%-15%。MUS的定义是描述性的，在基层医疗中没有针对MUS的具体诊断标准。此外，全科医生（GP）对患有MUS的患者的分类差异很大。本研究的目的是调查全科医生如何运用MUS的定义以及他们在日常实践中如何管理患有MUS的患者。方法。采用扎根理论方法，对全科医生进行了五次焦点小组访谈。访谈内容涉及全科医生如何管理MUS以及他们对MUS患者病程和预后的思考。结果。关于MUS的会诊围绕个体患者展开，通常包括多次预约。我们确定了三种不同类型的会诊：（1）“寻找疾病”，（2）“按常规行事”，以及（3）“探索多种途径”。这些会诊类型涵盖了从生物医学方法到提供多种解释以说明患者问题的方法。会诊类型的选择受到全科医生、患者和背景因素的影响，而这些因素又反过来影响诊断过程。结论。MUS的诊断是与背景相关的，诊断过程受会诊的影响。
