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Normalisation of unexplained symptoms by general practitioners: a functional typology
Christopher F Dowrick1, Adele Ring, Gerry M Humphris
1Department of Primary Care, University of Liverpool, Liverpool. cfd@liv.ac.uk
Summary
General practitioners' (GPs) use of normalising explanations for medically unexplained symptoms can be ineffective, sometimes worsening patient presentations. However, effective explanations linking physical and psychological factors can improve outcomes and reduce unnecessary treatments.
Area of Science:
- General Practice
- Psychosomatic Medicine
- Communication in Healthcare
Background:
- Patients frequently present with physical symptoms lacking clear medical explanation.
- Reassuring these patients is a complex and poorly understood aspect of primary care.
Purpose of the Study:
- To categorize general practitioners' (GPs) normalising explanations.
- To assess the impact of these explanations on consultations for patients with medically unexplained symptoms.
Main Methods:
- Qualitative analysis of 21 GPs and 36 patients in Merseyside, UK.
- Inductive analysis of transcribed consultations to identify types of normalising speech.
Main Results:
- Ineffective normalisation (rudimentary reassurance, negative test results) led to patient persistence and symptom elaboration.
- Effective normalisation, linking physical and psychological factors to patient concerns, was accepted and facilitated psychosocial management.
Conclusions:
- Some GP normalisation strategies are counterproductive, potentially exacerbating patient symptoms.
- Effective explanations can reduce the need for further symptomatic investigation or treatment.
- Findings can guide educational interventions for GPs on managing medically unexplained symptoms.