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Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations.

Houwen, J., Lucassen, P.L., Dongelmans, S., Stappers, H.W., Assendelft, W.J., Dulmen, S. van, Olde Hartman, T.C. Medically unexplained symptoms: time to and triggers for diagnosis in primary care consultations. British Journal of General Practice: 2020, 70(691), e86-e94
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Background
It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.

Aim
To establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.

Design and setting
This was a qualitative study. Data were collected in the Netherlands in 2015.

Method
GPs’ consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.

Results
A total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.

Conclusion
Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients’ symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.