den Boeft Madelon, Huisman Danielle, van der Wouden Johannes C, Numans Mattijs E, van der Horst Henriette E, Lucassen Peter L, Olde Hartman Tim C
Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.
Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
BMC Fam Pract. 2016 May 12;17:55. doi: 10.1186/s12875-016-0451-x.
Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they recognize specific subgroups of patients with MUPS. Targeting such subgroups might improve treatment outcomes.
Six focus groups were conducted with in total 29 Dutch FPs. Two researchers independently analysed the data applying the principles of constant comparative analysis in order to detect characteristics to recognize MUPS and to synthesize subgroups.
FPs take into account various characteristics when recognizing MUPS in their patients. More objective characteristics were multiple MUPS, frequent and long consultations and many referrals. Subjective characteristics were negative feelings towards patients and the feeling that the FP cannot make sense of the patient's story. Experience of the FP, affinity with MUPS, consultation skills, knowledge of the patient's context and the doctor-patient relationship seemed to influence how and to what extent these characteristics play a role. Based on the perceptions of the FPs we were able to distinguish five subgroups of patients according to FPs: 1) the anxious MUPS patient, 2) the unhappy MUPS patient, 3) the passive MUPS patient, 4) the distressed MUPS patient, and 5) the puzzled MUPS patient. These subgroups were not mutually exclusive, but were based on how explicit and predominant certain characteristics were perceived by FPs.
FPs believe that they can properly identify MUPS in their patients during consultations and five distinct subgroups of patients could be distinguished. If these subgroups can be confirmed in further research, personalized treatment strategies can be developed and tested for their effectiveness.
患有医学上无法解释的身体症状（MUPS）的患者构成了一个异质性群体，并且经常就诊于他们的家庭医生（FP）。关于家庭医生如何识别其患者中的MUPS，人们知之甚少。我们进行了一项焦点小组研究，以探讨家庭医生如何识别MUPS，以及他们是否识别出患有MUPS的特定患者亚组。针对这些亚组可能会改善治疗效果。
对总共29名荷兰家庭医生进行了6个焦点小组访谈。两名研究人员运用持续比较分析原则独立分析数据，以检测识别MUPS的特征并综合亚组。
家庭医生在识别患者中的MUPS时会考虑各种特征。更客观的特征是多种MUPS、频繁且长时间的咨询以及多次转诊。主观特征是对患者的负面情绪以及家庭医生无法理解患者病情的感觉。家庭医生的经验、对MUPS的亲和力、咨询技巧、对患者背景的了解以及医患关系似乎会影响这些特征如何以及在多大程度上发挥作用。根据家庭医生的看法，我们能够区分出五类患者亚组：1）焦虑的MUPS患者，2）不开心的MUPS患者，3）被动的MUPS患者，4）痛苦的MUPS患者，以及5）困惑的MUPS患者。这些亚组并非相互排斥，而是基于家庭医生对某些特征的明确和主导程度的感知。
家庭医生认为他们在会诊期间能够正确识别患者中的MUPS，并且可以区分出五个不同的患者亚组。如果这些亚组能够在进一步研究中得到证实，就可以制定个性化的治疗策略并测试其有效性。
