Centre for Language Studies, Radboud University.
Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences.
Health Commun. 2022 May;37(6):696-707. doi: 10.1080/10410236.2020.1864888. Epub 2021 Jan 13.
A common explanation for medically unexplained symptoms (MUS) relates patients' psychosocial concerns to their physical ailments. The present study used conversation analysis to examine how general practitioners (GPs) ascribe psychosocial causes to patients' unexplained symptoms during medical consultations. Our data consisted of 36 recorded consultations from Dutch general practice. We found that GPs raise psychosocial concerns as a potential cause of MUS in 14 consultations, either captured in 1) history-taking questions, or 2) diagnostic explanations. Whereas questions invited patient ideas, explanations did not make relevant patient responses in adjacent turns and subordinated patients' knowledge in symptom experiences to the GP's medical expertise. By questioning patients whether their symptoms may have psychosocial causes GPs enabled symptom explanations to be constructed collaboratively. Furthermore, additional data exploration showed that GPs lay ground for psychosocial ascriptions by first introducing psychosocial concerns as a consequence rather than a cause of complaints. Such preliminary activities allowed GPs to initiate rather delicate psychosocial ascriptions later in the consultation.
对于无法用医学解释的症状（MUS），有一种常见的解释是将患者的心理社会问题与他们的身体疾病联系起来。本研究使用会话分析来研究全科医生（GP）如何在医疗咨询中为患者的不明原因症状赋予心理社会原因。我们的数据包括来自荷兰普通实践的 36 次记录咨询。我们发现，在 14 次咨询中，GP 将心理社会问题作为 MUS 的潜在原因提出，要么出现在 1）病史询问问题中，要么出现在 2）诊断解释中。问题邀请患者提出想法，而解释并没有在相邻的轮次中让患者做出相关的回应，并将患者在症状体验中的知识置于 GP 的医学专业知识之下。通过询问患者他们的症状是否可能有心理社会原因，GP 使症状解释能够共同构建。此外，进一步的数据探索表明，GP 通过首先将心理社会问题作为抱怨的结果而不是原因来引入心理社会问题，为心理社会归因奠定了基础。这些初步的活动使 GP 能够在咨询的后期更巧妙地进行心理社会归因。
