Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis

Madelon den Boeft, Daniëlle Huisman, Lakrista Morton, Peter Lucassen, Johannes C van der Wouden, Marjan J Westerman, Henriëtte E van der Horst, Christopher D Burton

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations.

OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes.

METHODS: Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes.

RESULTS: We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted.

CONCLUSION: We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research.

Original languageEnglish
Pages (from-to)107-113
Number of pages7
JournalFamily Practice
Issue number1
Early online date19 Nov 2016
Publication statusPublished - 1 Feb 2017

Bibliographical note

The authors thank all the participating GPs and patients in this study.

This analysis was funded by a grant from VGZ Health Insurances and is part of the program for Innovation and Quality of Academic Primary Care. The program was set up to improve quality of care for patients with medically unexplained physical symptoms in primary care.


  • physician-patient relations
  • psychosomatic medicine
  • communication
  • primary health care
  • qualitative research
  • somatoform disorders
  • diagnosis
  • aetiology
  • psychology


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