Caring for patients with persistent physical symptoms for which no adequate explanation can be found - Medically Unexplained Symptoms (MUS) - in general practice can be challenging and frustrating, for both the doctor and the patient. Researchers in Norway have identified ways in which experienced GPs have successfully managed patients with MUS, elicited during a series of focus groups and interviews, which may provide a useful framework for the consultation.
The essence of successful approaches is to show the patient that they are taken absolutely seriously, with painstaking attention being paid to details of their medical history and examination, repeatedly confirmed for accuracy with the patient. Sharing the meaning and interpretation of symptoms with the patient is crucial, as is negotiating and agreeing on any proposed intervention.
A common sense, down-to-earth, approach to communication should be used. Sometimes agreeing with a patient's idiosyncratic interpretation of their symptoms can be helpful, although some GPs reported confrontational exchanges which led to a better therapeutic relationship. Trying to avoid using conventional explanatory models, which do not fit, and working with patients to think of innovative explanations for symptoms can also be helpful.
Article: Helpful strategies for GPs seeing patients with medically unexplained physical symptoms: a focus group study, Aase Aamland, Anette Fosse, Eline Ree, Eirik Abildsnes and Kirsti Malterud, British Journal of General Practice, doi: 10.3399/bjgp17X691697, published 3 July 2017.