General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study

Dowrick, Christopher, Gask, Linda, Hughes, John G, Charles-Jones, Huw, Hogg, Judith A, Peters, Sarah, Salmon, Peter ORCID: 0000-0001-6450-5209, Rogers, Anne R and Morriss, Richard K (2008) General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study. BMC FAMILY PRACTICE, 9 (1). 46-.

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Abstract

<h4>Background</h4>The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice.<h4>Methods</h4>A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data.<h4>Results</h4>Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context.<h4>Conclusion</h4>Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice.

Item Type:	Article
Additional Information:	10 pages (page numbers not for citation purposes). Published: 19 August 2008.
Uncontrolled Keywords:	Humans, Diagnostic Techniques and Procedures, Attitude of Health Personnel, Physician-Patient Relations, Somatoform Disorders, Qualitative Research, Education, Medical, Continuing, Clinical Competence, Adult, Aged, Middle Aged, Physicians, Family, England, Female, Male, Interviews as Topic, Surveys and Questionnaires
Subjects:	?? R1 ??
Divisions:	Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	05 Nov 2008 16:37
Last Modified:	16 Dec 2022 02:13
DOI:	10.1186/1471-2296-9-46
Publisher's Statement :	© 2008 Dowrick et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/893