Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?

Salmon, Peter; Wissow, Larry; Carroll, Janine; Ring, Adele; Humphris, Gerry M.; Davies, John C.; Dowrick, Christopher F.

doi:10.1016/j.genhosppsych.2007.06.003

« Previous Next »General Hospital Psychiatry
Volume 29, Issue 5 , Pages 454-460, September 2007

Doctors' responses to patients with medically unexplained symptoms who seek emotional support: criticism or confrontation?

Peter Salmon, M.Sc., D.Phil.
- Division of Clinical Psychology, University of Liverpool, Brownlow Hill, L69 3GB Liverpool, UK
- Corresponding author. Tel.: +44 151 794 5531; fax: +44 151 794 5537.
Larry Wissow, M.D.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Janine Carroll, B.Sc.
- Division of Clinical Psychology, University of Liverpool, Brownlow Hill, L69 3GB Liverpool, UK
Adele Ring, B.Sc., R.G.N.
- Division of Primary Care, University of Liverpool, L69 3GB Liverpool, UK
Gerry M. Humphris, M.Sc., Ph.D.
- Bute Medical School, University of St. Andrews, Fife KY16 9TS, Scotland
John C. Davies, Ph.D.
- Computing Services Department, University of Liverpool, Chadwick Tower, L69 3BX Liverpool, UK
Christopher F. Dowrick, M.D.
- Division of Primary Care, University of Liverpool, L69 3GB Liverpool, UK

Received 10 December 2006; accepted 12 June 2007.

Abstract

Objective

Consultations about medically unexplained symptoms (MUSs) can resemble contests over the legitimacy of patients' demands. To understand doctors' motivations for speech appearing to be critical of patients with MUSs, we tested predictions that its frequency would be related to patients' demands for emotional support and doctors' patient-centered attitudes as well as adult attachment style.

Methods

Twenty-four general practitioners identified 249 consecutive patients presenting with MUSs and indicated their own patient-centered attitudes as well as adult attachment style (positive models of self and others). Before consultation, patients self-reported their desire for emotional support. Consultations were audio recorded and coded utterance by utterance. The number of utterances coded as criticism was the response variable in the multilevel regression analyses.

Results

Frequency of criticism was positively related to patients' demands for emotional support, to doctors' belief in sharing responsibility with patients and to doctors' positive model of themselves. It was inversely associated with doctors' belief that patients' feelings were legitimate business for consultation and was unrelated to their model of others.

Conclusions

From the perspective of doctors, speech that appears to be critical probably reflects therapeutic intent and might therefore be better described as “confrontation.” Understanding doctors' motivations for what they say to patients with MUSs will allow for more effective interventions to improve the quality of consultations.

Keywords: Primary care, Medically unexplained symptoms, Communication