A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Lakrista Morton; Alison Elliott; Jennifer Cleland; Vincent Deary; Christopher Burton

doi:10.1016/j.pec.2016.08.015

A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Lakrista Morton
, Alison Elliott
, Jennifer Cleland
, Vincent Deary
, Christopher Burton

Northumbria University

Research output: Contribution to journal › Article › peer-review

31 Citations (Scopus)

25 Downloads (Pure)

Abstract

Objective: To develop a taxonomy of explanations for patients with persistent physical symptoms.

Methods: We analysed doctors’ explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often “medically-unexplained,” physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations.

Results: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These
differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts – generic statements about normal or dysfunctional processes; Causes – person-specific statements about proximal or distal causes for symptoms; Mechanisms –processes by which symptoms arise or persist in the individual. Most
explanations conformed to one type and contained several components.

Conclusions: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.

Original language	English
Pages (from-to)	224–230
Number of pages	7
Journal	Patient Education and Counseling
Volume	100
Issue number	2
Early online date	17 Aug 2016
DOIs	https://doi.org/10.1016/j.pec.2016.08.015
Publication status	Published - 1 Feb 2017

Bibliographical note

MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies.

Keywords

medically unexplained symptoms
somatoform disorders
explanation
reassurance
primary care

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Accepted Manuscript
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 648 KBLicence: CC BY-NC-ND

Cite this

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title = "A taxonomy of explanations in a general practitioner clinic for patients with persistent {\textquotedblleft}medically unexplained{\textquotedblright} physical symptoms",

abstract = "Objective: To develop a taxonomy of explanations for patients with persistent physical symptoms. Methods: We analysed doctors{\textquoteright} explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often {\textquotedblleft}medically-unexplained,{\textquotedblright} physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. Results: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts {\textendash} generic statements about normal or dysfunctional processes; Causes {\textendash} person-specific statements about proximal or distal causes for symptoms; Mechanisms {\textendash}processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components. Conclusions: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency. ",

keywords = "medically unexplained symptoms, somatoform disorders, explanation , reassurance, primary care",

author = "Lakrista Morton and Alison Elliott and Jennifer Cleland and Vincent Deary and Christopher Burton",

note = "MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies. ",

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AU - Morton, Lakrista

AU - Elliott, Alison

AU - Cleland, Jennifer

AU - Deary, Vincent

AU - Burton, Christopher

N1 - MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies.

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N2 - Objective: To develop a taxonomy of explanations for patients with persistent physical symptoms. Methods: We analysed doctors’ explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often “medically-unexplained,” physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. Results: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts – generic statements about normal or dysfunctional processes; Causes – person-specific statements about proximal or distal causes for symptoms; Mechanisms –processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components. Conclusions: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.

AB - Objective: To develop a taxonomy of explanations for patients with persistent physical symptoms. Methods: We analysed doctors’ explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often “medically-unexplained,” physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. Results: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts – generic statements about normal or dysfunctional processes; Causes – person-specific statements about proximal or distal causes for symptoms; Mechanisms –processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components. Conclusions: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.

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JO - Patient Education and Counseling

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ER -

A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Abstract

Bibliographical note

Keywords

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