The impact of familiarity on doctor-patient interaction during primary care consultations pertaining to medically unexplained symptoms (MUS)

• Main Author: Wheeler, Sara Louise
• Published: University of Liverpool 2011
• Subjects: 610.696
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.569255

It is common in all areas of medicine for patients to present with symptoms which cannot be adequately explained by the Western biomedical criteria of recognisable organic pathology. In this situation the social and clinical predicament of the patient is characterised by uncertainty and can lead to unnecessary emotional, social and legal difficulties. Since primary care is the forefront of diagnosis and management in the UK, General Practitioners deal regularly with uncertain and contested illness. Patients presenting Medically Unexplained Symptoms (MUS) represent a challenge to GPs in terms of their professional abilities and GPs may feel, rightly or wrongly, a 'pressure to prescribe' from patients, whilst also experiencing a pressure not to prescribe from their colleagues in secondary care specialisms. The widely held view of primary care is that a familiarity between doctor and patient is the most auspicious milieu, particularly in terms of managing chronic illness. However the concept lacks precision, whilst a growing body of research suggests a more complex picture. Drawing on the concept of researcher as 'Bricoleuse(1)', an innovative methodological approach was adopted for exploring the nature of familiarity and non-familiarity within the primary care setting and its impact on doctor-patient interaction in terms of the management of MUS. Consecutive patients attending primary care physicians were recruited and their consultations recorded. GPs identified consultations containing MUS. Semi-structured, tape-assisted recall interviews were conducted with participating GPs and, where possible, with the patients. Transcripts were analysed thematically, triangulating between the three data sources. Data collection was conducted at five primary care surgeries across Merseyside: three large practices which had several GPs and other available services, and two single GP practices. The total number of cases collected was 23, 12 of which were 'full', consisting of three data sources: consultation, post-consultation interviews with GPs and post- consultation interviews with patients. A further 11 cases consisted of two data sources: consultations and post-consultation GP interviews. Interpretation of the data revealed that the familiarity or non-familiarity a patient had with the health care setting generally, and more specifically a particular surgery and/ or GP, often did conspicuously influence the nature and course of the interaction during the consultation. This was confirmed by GPs reflecting on their familiarity or non-familiarity with particular patients and specific communities. Interestingly examples emerged of positive and negative aspects of familiarity and of non- familiarity. The findings of this research provide an original contribution to the understanding of Medically Unexplained Symptoms within the wider context of contested illness and uncertainty in the primary health care setting. The complex social and clinical nature of this cohort of patients warrants an equally complex approach in terms of meeting their needs, including recognition that whilst in some cases familiarity may be conducive to management, in other cases non-familiarity may be just as useful and desirable. These findings have further resonance for the field of primary care more generally since they highlight the complexity of GP work and promote the value of 'choice '. 1 In most of the literature where reference is made to the person performing the act of 'bricolage', the term 'bricoleur' is used; however this is the masculine form of the noun, and since the researcher is female, the feminine form 'bricoleuse' is used (WordReference.com accessed 7th December 2011).