Patients with Medically Unexplained Symptoms in Primary Care: Perception of the Patients and their Doctors

Martin Seifert

Keywords: medically unexplained symptoms, primary care, general practitioners, patient perception, somatization, psychosomatic care, qualitative study

Background:

Patients with medically unexplained symptoms (MUS) make up a significant proportion of patients in general practice and can be very burdensome for doctors and the whole health and social care system. Czech general practitioners (GPs) can officially achieve second medical specialization in Psychosomatic medicine which is based on many courses, months of internships, around 250 hours of self-experience, an original paper and finally an oral exam. There is an original Czech guideline on primary care of patients with MUS. Yet, there has been no research focusing on patients with MUS or with somatization disorders in primary care or their GPs in the Czech Republic.

Research questions:

What do patients with MUS expect from their GPs? How do they experience the role of their GP in their illness?
What is the perception of the Czech GPs with and without psychosomatic education of their role in care of patients with MUS? What are their needs in delivering the best care for their patients with MUS?

Method:

We currently analyse the results of an on-line questionnaire focused on experience with care of patients with MUS filled by 152 GPs. We performed thematic analysis of three open questions.
We will carry out individual in-depth semi-structured interviews with patients with MUS lasting at least 3 months identified by their GPs and with the GPs of these patients. We will also do focus groups with GPs without and with GPs with psychosomatic training facilitated by a psychotherapist with experience with MUS patients. We will perform thematic analysis of all the data collected from records of the interviews and the focus groups.

Results:

Conclusions:

We expect to identify the potentials for improvement of the care for patients with MUS by their GPs and also to identify significant barriers to improving patient outcomes.

Points for discussion:

What should be the right cost-effective psychosomatic education for GPs? Ellective or for everybody?

How should the cost-effective psychosomatic intervention in primary care look like?

How to identify the "psychosomatic" patients in general practice and how to select the patients for the study?