Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131 Mainz, Germany.
Int J Environ Res Public Health. 2024 Jul 10;21(7):901. doi: 10.3390/ijerph21070901.
Somatoform symptoms are widely spread in outpatient care. For treating physicians, it can be challenging to establish a relationship that is conducive to compliance and to take stabilising action when dealing with affected patients. As primary care providers, GPs are usually the first point of contact for patients with somatoform disorders; they set the course for stabilisation and further care. To date, there is a lack of studies that focus on how GPs respond to such patients. In particular, strategies for establishing a stable doctor-patient relationship have hardly been explored. Consequently, this study investigated how GPs recognise the symptoms of somatoform disorders, what significance they attach to them and how they handle patients. The primary focus is on experienced patient properties, assumed causes of somatoform disorders, obstacles and complexities in consultation, care and stabilisation strategies, as well as diagnostic forms of support. A total of 2797 GPs in the German federal states of Hesse, Rhineland-Palatinate and Baden-Württemberg were surveyed anonymously by means of a written questionnaire between January and August 2023. A t-test was performed with independent samples to determine significant differences between two groups. In addition, 64 GPs were interviewed between March and April by means of qualitative semi-standardised interviews. The respondents make use of a wide range of communication and stabilisation strategies when treating somatoform physical complaints. The GPs combine the establishment of a tangential doctor-patient relationship with measures to consistently exclude physical causes and to enable the best possible assessment of patients, as well as to gently introduce them to the clinical picture of somatoform disorders. Most physicians are not familiar with current clinical guidelines. Cooperation with specialists and therapists is widely described as complicated. GPs have access to a wide range of communication and stabilisation strategies for the management of somatoform physical complaints. Yet, they experience interaction with this patient group as difficult in daily practice. GPs articulate a clear need for more external support. Apart from increasing therapeutic care capacities and interdisciplinary structures, it seems advisable to extend low-threshold therapy and support services.
躯体形式症状广泛存在于门诊治疗中。对于治疗医生来说，与患者建立有利于依从性的关系并在处理受影响的患者时采取稳定措施是具有挑战性的。作为初级保健提供者，全科医生通常是躯体形式障碍患者的第一接触点；他们为稳定和进一步的治疗设定了方向。迄今为止，针对全科医生如何应对此类患者的研究还很少。特别是，建立稳定医患关系的策略几乎没有被探索过。因此，本研究调查了全科医生如何识别躯体形式障碍的症状、对这些症状的重视程度以及如何处理患者。主要重点是经验丰富的患者特征、躯体形式障碍的假设原因、咨询、护理和稳定化策略中的障碍和复杂性，以及诊断支持形式。2023 年 1 月至 8 月期间，通过书面问卷对德国黑森州、莱茵兰-普法尔茨州和巴登-符腾堡州的 2797 名全科医生进行了匿名调查。使用独立样本 t 检验确定两组之间的显著差异。此外，3 月至 4 月期间，通过定性半标准化访谈对 64 名全科医生进行了访谈。受访者在治疗躯体形式的身体投诉时会使用各种沟通和稳定化策略。全科医生在建立边缘医患关系的同时，还采取措施一致排除身体原因，并尽可能对患者进行最佳评估，以及向患者介绍躯体形式障碍的临床特征。大多数医生不熟悉当前的临床指南。与专家和治疗师的合作被广泛描述为复杂的。全科医生有多种沟通和稳定化策略来管理躯体形式的身体投诉。然而，他们在日常实践中感到与这组患者的互动很困难。全科医生明确表示需要更多的外部支持。除了增加治疗能力和跨学科结构外，似乎还需要扩大低门槛治疗和支持服务。
