• Sarah Peters, Anne Rogers, Peter Salmon, Linda Gask, Chris Dowrick, Maria Towey, Rebecca Clifford, and Richard Morriss.
• School of Psychological Sciences, University of Manchester, Manchester, UK. Sarah.peters@manchester.ac.uk
• J Gen Intern Med. 2009 Apr 1; 24 (4): 443449443-9.

BackgroundDespite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health.ObjectiveTo examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.DesignQualitative study.ParticipantsPatients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general.ApproachThematic analysis of in-depth interviews.ResultsPotential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.ConclusionsImproving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.

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