Explaining medically unexplained symptoms: somatizing patients' responses in primary care.

Area of Science:

• Psychiatry
• Psychology
• Medical Communication

Background:

• Somatizing patients often present with physical symptoms that lack a clear medical explanation.
• Physicians may use symptom explanations (SEs) to bridge the gap between physical complaints and psychological distress.
• Understanding the dynamics of these SEs is crucial for effective patient communication.

Purpose of the Study:

• To analyze how physicians explain symptoms as a hormonal imbalance to initiate psychosocial discussions with somatizing patients.
• To investigate how patients respond to these symptom explanations.

Main Methods:

• Qualitative study analyzing 11 physician-patient interaction sequences.
• Micro-analysis using Conversation Analysis (CA) to examine the structure and function of symptom explanations.

Main Results:

• Physicians' symptom explanations were often vague, tentative, and uncertain.
• Two patterns of SEs (general vs. specific) and five patterns of patient response were identified.
• Patient responses varied in timing and the effort required to verbalize agreement.

Conclusions:

• Symptom explanations, particularly those linking symptoms to hormonal imbalances, can elicit patient agreement and permission for psychosocial exploration.
• Physicians can effectively initiate these discussions by connecting symptoms to common emotions and situations.
• Overly complex explanations or excessive focus on patient agreement may hinder communication.