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Related Experiment Videos

Physicians' responses to patients' medically unexplained symptoms.

Ronald M Epstein1, Cleveland G Shields, Sean C Meldrum

  • 1Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA. Ronald_Epstein@urmc.rochester.edu

Psychosomatic Medicine
|March 24, 2006
PubMed
Summary

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Physicians explored symptoms less thoroughly and offered less validation to patients with medically unexplained symptoms (MUS) compared to those with clear diagnoses. This communication gap may contribute to mistrust and poor outcomes in MUS patients.

Area of Science:

  • Medical communication
  • Patient-physician relationship
  • Psychosomatic medicine

Background:

  • Medically unexplained symptoms (MUS) are associated with mistrust and poor clinical outcomes.
  • Physician communication styles may play a role in these observed disparities.

Purpose of the Study:

  • To investigate how physician communication patterns influence patient mistrust and clinical outcomes in patients with MUS.
  • To compare physician communication during visits for MUS versus classic gastroesophageal reflux disease (GERD) presentations.

Main Methods:

  • 100 primary care physicians audio-recorded encounters with covert standardized patients (SPs) portraying either GERD or MUS chest pain scenarios.
  • The Measure of Patient-Centered Communication (MPCC) tool assessed physician exploration of illness experience (component 1), psychosocial context (component 2), and common ground (component 3).

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Main Results:

  • Physicians scored significantly lower on MPCC component 1 (illness experience exploration) during MUS visits compared to GERD visits (p = .01).
  • Symptom exploration and validation of patient concerns were less frequent in MUS encounters.
  • No significant differences were found in physician exploration of psychosocial context (component 2) or attempts to find common ground (component 3).

Conclusions:

  • Physician communication, specifically symptom inquiry and validation, is less effective for patients with MUS.
  • Further research is needed to link communication variables to poor outcomes, mistrust, and healthcare utilization in MUS patients.
  • Interventions to improve physician communication with MUS patients are warranted.