Managing Long Term Symptoms, with Complex Causes: A Survey of Patient and General Practitioner Experiences

The term ‘Medically Unexplained Symptoms’ (MUS) refers to a constellation of symptoms that have a low probability of disease pathology. It is a clinical area that General Practitioners (GPs) have frequent contact with; managing the challenge of how to reduce the reported discrepancy between patient expectation of cure and the provider approach of symptom management. The aim of this current study is to explore how patients and GPs understand MUS and its management, considering how their understandings overlap and diverge, how any differences are negotiated and how this can inform future collaborative care interventions for MUS. Six patients and four GPs were recruited from one practice, and an interview design was used to explore their experiences of managing MUS. The qualitative data were analysed using the framework approach, with patient and GP interview data being analysed separately, before being synthesised. Three conceptual themes emerged from GP and patient interviews- understanding of the symptom(s), the emotion response, the validating relationship, with one further conceptual theme present for patient interviews- deciding what gets shared in the consultation. The study results provide some support to existing research that have suggested that patients do have a complex understanding of their MUS symptoms. There was also a shared belief between participant groups that the relationship between patient and GP was important in the management of MUS, however a gap in communication between patient and GP was also highlighted. The results are considered in relation to existing interventions that are used to open up the shared dialogue between patient and GP. The clinical implications of introducing a shared decision making approach to MUS consultations are discussed, alongside implications for future research of how this intervention might be piloted.