Why do general practitioners decline training to improve management of medically unexplained symptoms?

Peter Salmon, Sarah Peters, Rebecca Clifford, Wendy Iredale, Linda Gask, Anne Rogers, Christopher Dowrick, John Hughes, Richard Morriss

    Research output: Contribution to journalArticlepeer-review


    BACKGROUND: General practitioners' (GPs) communication with patients presenting medically unexplained symptoms (MUS) has the potential to somatize patients' problems and intensify dependence on medical care. Several reports indicate that GPs have negative attitudes about patients with MUS. If these attitudes deter participation in training or other methods to improve communication, practitioners who most need help will not receive it. OBJECTIVE: To identify how GPs' attitudes to patients with MUS might inhibit their participation with training to improve management. DESIGN: Qualitative study. PARTICIPANTS: GPs (N=33) who had declined or accepted training in reattribution techniques in the context of a research trial. APPROACH: GPs were interviewed and their accounts analysed qualitatively. RESULTS: Although attitudes that devalued patients with MUS were common in practitioners who had declined training, these coexisted, in the same practitioners, with evidence of intuitive and elaborate psychological work with these patients. However, these practitioners devalued their psychological skills. GPs who had accepted training also described working psychologically with MUS but devalued neither patients with MUS nor their own psychological skills. CONCLUSIONS: GPs' attitudes that suggested disengagement from patients with MUS belied their pursuit of psychological objectives. We therefore suggest that, whereas negative attitudes to patients have previously been regarded as the main barrier to involvement in measures to improve patient management, GPs devaluing of their own psychological skills with these patients may be more important. © 2007 Society of General Internal Medicine.
    Original languageEnglish
    Pages (from-to)565-571
    Number of pages6
    JournalJournal of General Internal Medicine
    Issue number5
    Publication statusPublished - May 2007


    • Attitudes
    • General practitioners
    • Management
    • Medically unexplained symptoms
    • Psychological skills


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