Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study

Area of Science:

• Medical Communication
• General Practice
• Psychosomatic Medicine

Background:

• General practitioners (GPs) frequently encounter difficulties communicating with patients presenting with medically unexplained symptoms (MUS).
• Effective communication is crucial for managing MUS consultations and improving patient outcomes.

Purpose of the Study:

• To identify specific communication challenges faced by GPs during consultations with patients experiencing MUS.
• To pinpoint areas for improvement in GP communication strategies for MUS.

Main Methods:

• Video-recorded consultations of GPs and patients with MUS.
• Qualitative analysis of semi-structured interviews with GPs and patients reflecting on consultations.
• Constant comparative analysis of selected consultation fragments where communication difficulties were identified.

Main Results:

• GPs identified 84 communication difficulties across 60 fragments in 28 MUS consultations.
• Key areas for improvement include psychosocial exploration, consultation structure (summaries, agenda setting), and person-centredness (reason for appointment, patient's story, decision sharing).
• Patient perspectives in difficult consultations revealed an absence of dialogue, characterized by GPs focusing on their own concepts, asking closed questions, and interrupting patients.

Conclusions:

• GPs acknowledge the need for improved communication in MUS consultations.
• Enhancing psychosocial exploration, consultation structure, and person-centred communication are vital for GPs.
• Absence of dialogue, characterized by specific GP behaviors, significantly impacts patient experience in MUS consultations.