How GPs think about persistent or “medically unexplained” symptoms: a qualitative interview study

THE PROBLEM:

Approximately 45% of patients have at least one medically unexplained symptom (MUS) and they therefore represent a large portion of GP workload. The exact causes of MUS are uncertain and while a range of plausible mechanisms exist, they are often referred to as ‘medically unexplained’. Philosophical positions inform how doctors think about disease, and in cases with no identifiable pathology their philosophical worldviews become particularly important. The objective of this research was to explore how GPs think about medically unexplained symptoms, both in terms of what they are (metaphysics and ontology) and how they can be known about (epistemology).

YOUR APPROACH:

Qualitative research techniques were used. Six thirty-minute semi-structured interviews with individual GPs were recorded. Eligible GPs were contacted through staff lists at the Academic Unit of Primary Medical Care (AUPMC), and a notice in the Sheffield-wide NHS GP bulletin. Transcripts were analysed using a framework approach.

THE LEARNING:

All GPs interviewed mixed philosophical approaches to varying extents. Two GPs appeared to show a primarily biomedical approach, two a primarily humanistic approach, one an equally biomedical and humanistic approach, and one did not clearly reveal an approach. Findings appeared to show the mixing of philosophical approaches may be a pragmatic choice in order to improve outcomes, or that it may be unconscious.

WHY IT MATTERS:

If GPs have such different philosophical worldviews, this may affect the acceptability of explanations to them and have implications for education on MUS. However, this research suggests that the approaches to understanding MUS developed within the AUPMC had been acceptable to GPs regardless of their apparent philosophical worldviews and had given them the tools to legitimise their patients’ experiences. Additionally, understanding philosophical worldviews and pragmatically using philosophical approaches may enhance the clinical skills of GPs.

Presenting author: Hannah Andrew BMedSci, Academic Unit of Primary Medical Care, University of Sheffield Medical School, hlandrew1@sheffield.ac.uk