Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms

Background: Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms. Aims: To determine if practice-based training of GPs in reattribution changes doctor-patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration. Method: Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual. Results: With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002).Training was associated with decreased quality of life (health thermometer difference -0.9, 95% CI -1.6 to -0.1; P=0.027) with no other effects on patient outcome or health contacts. Conclusions: Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.