Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

Madelon den Boeft*, Danielle Huisman, Johannes C van der Wouden, Mattijs E. Numans, Henriëtte E. van der Horst, Peter Lucassen, Tim C. olde Hartman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

19 Citations (Scopus)
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Abstract

Background
Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they recognize specific subgroups of patients with MUPS. Targeting such subgroups might improve treatment outcomes.

Methods
Six focus groups were conducted with in total 29 Dutch FPs. Two researchers independently analysed the data applying the principles of constant comparative analysis in order to detect characteristics to recognize MUPS and to synthesize subgroups.

Results
FPs take into account various characteristics when recognizing MUPS in their patients. More objective characteristics were multiple MUPS, frequent and long consultations and many referrals. Subjective characteristics were negative feelings towards patients and the feeling that the FP cannot make sense of the patient’s story. Experience of the FP, affinity with MUPS, consultation skills, knowledge of the patient’s context and the doctor-patient relationship seemed to influence how and to what extent these characteristics play a role. Based on the perceptions of the FPs we were able to distinguish five subgroups of patients according to FPs: 1) the anxious MUPS patient, 2) the unhappy MUPS patient, 3) the passive MUPS patient, 4) the distressed MUPS patient, and 5) the puzzled MUPS patient. These subgroups were not mutually exclusive, but were based on how explicit and predominant certain characteristics were perceived by FPs.

Conclusions
FPs believe that they can properly identify MUPS in their patients during consultations and five distinct subgroups of patients could be distinguished. If these subgroups can be confirmed in further research, personalized treatment strategies can be developed and tested for their effectiveness.
Original languageEnglish
Article number55
JournalBMC Family Practice
DOIs
Publication statusPublished - 12 May 2016
Externally publishedYes

Bibliographical note

Funding
This study was funded by a grant from VGZ Health Insurances and is part of the program for Innovation and Quality of Academic Primary Care. The program was set up to improve quality of care for patients with medically unexplained physical symptoms in primary care. The funder had no role in the design, analysis and interpretation of this study.

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