Physicians' responses to patients' medically unexplained symptoms
Physicians' responses to patients' medically unexplained symptoms
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DOI：
10.1097/01.psy.0000204652.27246.5b
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发表时间：
2006-03-01
影响因子：
3.3
通讯作者：
Duberstein, PR
中科院分区：
文献类型：
--
作者：
Epstein, RM;Shields, CG;Duberstein, PR
目的：了解医生如何沟通可能导致出现医学上不明原因症状(MUS)的患者的不信任和不良的临床结果。方法：在提供知情同意后，纽约大罗切斯特的100名初级保健医生接受了两名未经宣布的秘密标准化患者的访问，他们扮演两个胸痛角色：典型的胃食道反流病(GERD)伴有恶心和失眠的症状(GERD角色)和特征不佳的胸痛并伴有疲劳和头晕(MUS角色)。这些访问被偷偷录制下来，并使用以患者为中心的沟通(MPCC)的衡量标准进行分析，该标准对医生对患者的疾病经历(组成部分1)和心理社会背景(组成部分2)的探索以及他们试图在诊断和治疗方面找到共同点(组成部分3)进行评分。结果：在多变量分析中，MUS访问在MPCC组成部分1上的得分显著降低(p=0.01)。成分1得分的子分析表明，患者的症状没有得到充分的探索，在MU中，验证不太可能被用于回应患者的担忧，而不是在GERD就诊中。成分2和成分3没有变化。结论：与医学上更直接的患者陈述相比，医生对MUS患者的症状进行询问和确认的情况较少。进一步的研究应该研究沟通变量与不良的临床结果、误解、相互不信任和不适当的医疗保健利用之间的关系，并测试解决这个问题的干预措施。
Objective: To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS). Methods: After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3). Results: In multivariate analyses, MUS visits yielded significantly lower scores on MPCC component 1 (p = .01). Subanalysis of component 1 scores showed that patients' symptoms were not explored as fully and that validation was less likely to be used in response to patient concerns in the MUS than in the GERD visits. Component 2 and component 3 were unchanged. Conclusion: Physicians' inquiry into and validation of symptoms in patients with MUS was less common compared with more medically straightforward patient presentations. Further research should study the relationship between communication variables and poor clinical Outcomes, misunderstandings, mutual distrust, and inappropriate healthcare utilization in this population, and test interventions to address this problem.