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Research Article

Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners.

Peter Salmon, Christopher F Dowrick, Adele Ring and Gerry M Humphris
British Journal of General Practice 2004; 54 (500): 171-176.
Peter Salmon
Department of Clinical Psychology, University of Liverpool, Liverpool. psalmon@liv.ac.uk
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Christopher F Dowrick
Department of Clinical Psychology, University of Liverpool, Liverpool. psalmon@liv.ac.uk
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Adele Ring
Department of Clinical Psychology, University of Liverpool, Liverpool. psalmon@liv.ac.uk
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Gerry M Humphris
Department of Clinical Psychology, University of Liverpool, Liverpool. psalmon@liv.ac.uk
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Abstract

BACKGROUND: Symptomatic investigation and treatment of unexplained physical symptoms is often attributed to patients' beliefs and demands for physical treatments. AIM: To test the influential assumption that patients who present symptoms that the general practitioner (GP) considers to be medically unexplained do not generally provide the opportunity for discussion of psychological issues. DESIGN OF STUDY: Qualitative analysis of audiotaped consultations between patients and GPs. SETTING: Seven general practices in Merseyside, United Kingdom. METHODS: Transcripts of audiotaped consultations between 21 GPs and 36 patients with medically unexplained symptoms were analysed inductively to identify opportunities that patients presented for their doctors to address emotional problems or their need for explanation. RESULTS: All but two patients provided psychological opportunities. They described social or emotional difficulties as problems of stress or mood. They presented their need for explanation by: explicit questions; statements of concern about symptoms; suggestions that disease might be absent; or tentative references to serious disease. In general, GPs did not engage with these cues. CONCLUSIONS: Patients with unexplained symptoms present opportunities for GPs to address psychological needs. By taking these opportunities, GPs might be able to avoid unnecessary symptomatic intervention.

Supplementary Material

Supplementary appendix 1. Details of patients Supplementary appendix 1
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British Journal of General Practice: 54 (500)
British Journal of General Practice
Vol. 54, Issue 500
March 2004
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Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners.
Peter Salmon, Christopher F Dowrick, Adele Ring, Gerry M Humphris
British Journal of General Practice 2004; 54 (500): 171-176.

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Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners.
Peter Salmon, Christopher F Dowrick, Adele Ring, Gerry M Humphris
British Journal of General Practice 2004; 54 (500): 171-176.
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Print ISSN: 0960-1643
Online ISSN: 1478-5242