Self-referral to primary care: symptoms and social factors

Previous analyses of data obtained from a comparative study of Health Centre consulters and controls have indicated that the influence of social and demographic factors upon consulting behaviour is slight compared with that of symptom severity. However, the samples were very heterogeneous and some variables may be influential for certain sub-groups but not for others. Subjects were classified according to whether they thought their symptoms were caused by internal physical, external physical or psychological factors. For all groups the likelihood of consultation was highest for those who said they had no idea what caused their ill-health and for those who thought it had an internal physical cause. A significant interaction between marital status and attributed cause showed that the reduced likelihood of consultation amongst women living in a stable relationship with husband or cohabitee, did not apply to those who attributed their symptoms to an external physical cause. Changes in patients' concepts of causation following the consultation with their doctor supported the idea that the GP often succeeds in reassuring patients who cannot understand their symptoms or who, without reason, fear they may be suffering from serious physical illness.