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Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure.
Psychosom Med. 2006 Jul-Aug; 68(4):570-7.PM

Abstract

OBJECTIVE

We test predictions from contrasting theories that primary care physicians offer medical care to patients with medically unexplained symptoms in response to a) patients' attribution of symptoms to disease and demand for treatment or b) their progressive elaboration of their symptoms in the attempt to engage their physicians.

METHODS

Primary care physicians identified consecutive patients who consulted with symptoms that the physician considered unexplained by physical disease. Four hundred twenty consultations with 36 physicians were audio recorded and transcribed, and physician and patient speech was coded turn by turn. Hierarchical logistic regression analysis modeled the probability of the physician proposing medical care as a function of the quantity of patients' speech of specific kinds that preceded it.

RESULTS

Whether physicians proposed medical care was unrelated to patients' attributions to disease or demands for treatment. Proposals of explicitly somatic responses (drugs, investigation or specialist referral) became more likely after patients had elaborated their symptoms and less likely after patients indicated psychosocial difficulties. Proposals of a further primary care consultation were responses simply to lengthening consultation.

CONCLUSIONS

The findings are incompatible with the influential assumption that physicians offer medical care to patients with unexplained symptoms because the patients demand treatment for a physical disease. Instead, the reason why many of these patients receive high levels of medical care should be sought by investigating the motivations behind physicians' responses to patients' symptom presentation.

Authors+Show Affiliations

Division of Clinical Psychology, Department of Clinical Psychology, University of Liverpool, Liverpool, England. psalmon@liv.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16868266

Citation

Salmon, Peter, et al. "Why Do Primary Care Physicians Propose Medical Care to Patients With Medically Unexplained Symptoms? a New Method of Sequence Analysis to Test Theories of Patient Pressure." Psychosomatic Medicine, vol. 68, no. 4, 2006, pp. 570-7.
Salmon P, Humphris GM, Ring A, et al. Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosom Med. 2006;68(4):570-7.
Salmon, P., Humphris, G. M., Ring, A., Davies, J. C., & Dowrick, C. F. (2006). Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosomatic Medicine, 68(4), 570-7.
Salmon P, et al. Why Do Primary Care Physicians Propose Medical Care to Patients With Medically Unexplained Symptoms? a New Method of Sequence Analysis to Test Theories of Patient Pressure. Psychosom Med. 2006 Jul-Aug;68(4):570-7. PubMed PMID: 16868266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. AU - Salmon,Peter, AU - Humphris,Gerry M, AU - Ring,Adele, AU - Davies,John C, AU - Dowrick,Christopher F, PY - 2006/7/27/pubmed PY - 2008/3/1/medline PY - 2006/7/27/entrez SP - 570 EP - 7 JF - Psychosomatic medicine JO - Psychosom Med VL - 68 IS - 4 N2 - OBJECTIVE: We test predictions from contrasting theories that primary care physicians offer medical care to patients with medically unexplained symptoms in response to a) patients' attribution of symptoms to disease and demand for treatment or b) their progressive elaboration of their symptoms in the attempt to engage their physicians. METHODS: Primary care physicians identified consecutive patients who consulted with symptoms that the physician considered unexplained by physical disease. Four hundred twenty consultations with 36 physicians were audio recorded and transcribed, and physician and patient speech was coded turn by turn. Hierarchical logistic regression analysis modeled the probability of the physician proposing medical care as a function of the quantity of patients' speech of specific kinds that preceded it. RESULTS: Whether physicians proposed medical care was unrelated to patients' attributions to disease or demands for treatment. Proposals of explicitly somatic responses (drugs, investigation or specialist referral) became more likely after patients had elaborated their symptoms and less likely after patients indicated psychosocial difficulties. Proposals of a further primary care consultation were responses simply to lengthening consultation. CONCLUSIONS: The findings are incompatible with the influential assumption that physicians offer medical care to patients with unexplained symptoms because the patients demand treatment for a physical disease. Instead, the reason why many of these patients receive high levels of medical care should be sought by investigating the motivations behind physicians' responses to patients' symptom presentation. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/16868266/Why_do_primary_care_physicians_propose_medical_care_to_patients_with_medically_unexplained_symptoms_A_new_method_of_sequence_analysis_to_test_theories_of_patient_pressure_ L2 - https://doi.org/10.1097/01.psy.0000227690.95757.64 DB - PRIME DP - Unbound Medicine ER -