Sowińska Agnieszka, Czachowski Sławomir
Department of English, Nicolaus Copernicus University, ul. W. Bojarskiego 1, 87-100, Toruń, Poland.
Department of Psychology and Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, ul. Gagarina 39, 87-100, Toruń, Poland.
BMC Fam Pract. 2018 Feb 2;19(1):23. doi: 10.1186/s12875-018-0709-6.
Patients with medically unexplained symptoms (MUS) are common in primary care, and pose a communicative and therapeutic challenge to GPs. Although much has been written about GPs' frustration and difficulties while dealing with these patients, research presenting the patients' perspectives on MUS still seems to be scarce. Existing studies have demonstrated the patients' desire to make sense of symptoms, addressed the necessity for appropriate and acceptable explanation of MUS, and revealed stigmatization of patients with symptoms of mental origin. Treatment in primary care should focus on the patient's most essential needs and concerns. The objective of this paper is to explore Polish patients' perspectives on living with MUS.
A qualitative content analysis of 20 filmed, semi-structured interviews with patients presenting MUS (8 men and 12 women, aged 18 to 57) was conducted. All patients were diagnosed with distinctive somatoform disorders (F45), and presented the symptoms for at least 2 years. The interviews were transcribed verbatim and analysed independently by two researchers.
Four major themes emerged: (1) experiences of symptoms; (2) explanations for symptoms; (3) coping; (4) expectations about healthcare. Within the first theme, the patients identified the following sub-themes: persistence of symptoms or variability, and negative emotions. Patients who observed that their symptoms had changed over time were better disposed to accept the existence of a relationship between the symptoms and the mind. The second theme embraced the following sub-themes: (1) personal explanations; (2) social explanations; (3) somatic explanations. The most effective coping strategies the patients mentioned included: the rationalization of the symptoms, self-development and ignoring the symptoms. The majority of our respondents had no expectations from the healthcare system, and stated they did not use medical services; instead, they admitted to visiting psychologists or psychiatrists privately.
Patients with MUS have their own experiences of illness. They undertake attempts to interpret their symptoms and learn to live with them. The role of the GP in this process is significant, especially when access to psychological help is restricted. Management of patients with MUS in the Polish healthcare system can be improved, if access to psychologists and psychotherapists is facilitated and increased financial resources are allocated for primary care. Patients with MUS can benefit from a video/filmed consultation with a follow-up analysis with their GP.
医学上无法解释的症状（MUS）患者在初级保健中很常见，给全科医生带来了沟通和治疗方面的挑战。尽管已经有很多关于全科医生在处理这些患者时的挫折感和困难的报道，但展示患者对MUS看法的研究似乎仍然很少。现有研究表明患者希望理解症状，强调了对MUS进行恰当且可接受解释的必要性，并揭示了对有精神源性症状患者的污名化。初级保健中的治疗应关注患者最基本的需求和担忧。本文的目的是探讨波兰患者对患有MUS的生活看法。
对20名患有MUS的患者（8名男性和12名女性，年龄在18至57岁之间）进行了录像的半结构化访谈，并进行了定性内容分析。所有患者均被诊断患有独特的躯体形式障碍（F45），且症状持续至少2年。访谈逐字记录，由两名研究人员独立分析。
出现了四个主要主题：（1）症状体验；（2）症状解释；（3）应对方式；（4）对医疗保健的期望。在第一个主题中，患者确定了以下子主题：症状的持续性或变异性以及负面情绪。观察到症状随时间变化的患者更愿意接受症状与心理之间存在关联。第二个主题包括以下子主题：（1）个人解释；（2）社会解释；（3）躯体解释。患者提到的最有效的应对策略包括：症状合理化、自我发展和忽视症状。大多数受访者对医疗保健系统没有期望，并表示他们不使用医疗服务；相反，他们承认私下咨询过心理学家或精神科医生。
患有MUS的患者有自己的患病经历。他们试图解释自己的症状并学会与之共处。全科医生在这个过程中的作用很重要，尤其是在获得心理帮助受限的情况下。如果能够更方便地接触到心理学家和心理治疗师，并为初级保健分配更多财政资源，波兰医疗保健系统中对患有MUS患者的管理可以得到改善。患有MUS的患者可以从与全科医生进行的视频/录像咨询及后续分析中受益。
