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Medically unexplained symptoms: the person, the symptoms and the dialogue.

Houwen, J., Lucassen, P., Stappers, H.W., Assendelft, P.J.J., Dulmen, S. van, Olde Hartman, T.C. Medically unexplained symptoms: the person, the symptoms and the dialogue. Family Practice: 2017, 34(2), 245-251
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Background
Many general practitioners (GPs) find the care for patients with medically unexplained symptoms (MUS) challenging. The patients themselves are often not satisfied with the care they receive.

Objectives
The aim of this study is to explore what patients with MUS expect from their GP by looking at relevant communication elements in consultations as identified by patients.

Methods
We video-recorded everyday consultations with GPs and asked the GPs immediately after the consultation whether MUS were presented. The patients in these MUS consultations were asked to reflect on the consultation during a semi-structured interview while watching a recording of their own MUS consultation. The interviews were analysed qualitatively according to the principles of constant comparative analysis.

Results
Of the 393 video-recorded consultations, 43 concerned MUS. All MUS patients said that they wanted to be taken seriously. According to the patients, their feeling of being taken seriously is enhanced when the GP:
(i) pays empathic attention to them as individuals, meaning that the GP knows their personal circumstances and has an open and empathic approach,
(ii) ensures a good conversation by treating the patient as an equal partner
(iii) is attentive to their symptoms by exploring these symptoms in depth and by acting on them.

Conclusion
Like chronic patients, patients with MUS value a personalised approach in which GPs pay attention to patients’ personal circumstances, to proper somatic management of their symptoms and to a proper conversation in which they are treated as equal partners. Use of these basic consultation skills may greatly improve care of MUS patients. (aut. ref.)