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What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies

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https://hdl.handle.net/10037/10491
DOI
https://doi.org/10.1016/j.pec.2016.11.015
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accepted manuscript version (PDF)
Date
2016-11-21
Type
Journal article
Tidsskriftartikkel
Peer reviewed

Author
Johansen, May-Lill; Risør, Mette Bech
Abstract
Objective To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. Methods We used meta-ethnography to synthesize qualitative studies on GPs’ perception and management of MUS. Results The problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless. In the face of cognitive incongruence, GPs have strived to achieve relational congruence with their patients. This has led to parallel positive experiences of mutual trust and validation. With more experience, some GPs seem to overcome the incongruences, and later studies point towards a reframing of the MUS problem. Conclusion For GPs, the challenge with MUS is most importantly at an epistemological level. Hence, a full reframing of the problem of MUS for GPs (and for patients) implies broad changes in basic medical knowledge and education. Practice implications Short-term: Improve management of patients with MUS by transferring experience-based, reality-adjusted knowledge from senior GPs to juniors. Long-term: Work towards new models of disease that integrate knowledge from all relevant disciplines.
Description
Accepted manuscript version. Published version at http://doi.org/10.1016/j.pec.2016.11.015. License in accordance with the journal's policy – CC-BY-NC-ND.
Publisher
Elsevier
Citation
Johansen M, Risør MB. What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies . Patient Education and Counseling. 2016
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