[Communication with patients who have medically unexplained symptoms: an art and a skill]

The relationship between doctors and patients often becomes tense when the patient has medically unexplained symptoms: doctors may experience frustration because they feel ill-equipped to provide their patients with a plausible explanation of the symptoms. Patients often feel that their doctor does not take them seriously and would like to understand why they are having symptoms. Research into the effect of the quality of the doctor-patient relationship and doctor-patient communication where medically unexplained symptoms are concerned has led to some recommendations for communication. A thorough exploration of all dimensions of the symptoms, i.e. the somatic, cognitive, emotional, behavioural and social dimensions, almost always yields starting points for explaining what is happening to the patient and for therapy. The provision of an explanation which is acceptable to the doctor as well as to the patient is an important condition for drawing up and carrying out therapy. If the doctor expresses confidence in the prognosis and outcome, this has a favourable effect on the development of the symptoms.