Identification of barriers and difficulties involved in the process of diagnosing somatic symptom disorders in primary care

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For most patients who suffer from functional somatic syndromes, general practitioners are the first point of contact with the health care system. Despite primary care's central role in the management of somatic symptom disorders, there are substantial problems in detecting patients with somatoform disorders in this setting. This has led to the under-diagnosis and under-treatment of somatic symptom disorders. According to the interdisciplinary German S3-guideline 'Non-specific, functional, and somatoform bodily complaints' (AWMF), there is a distinct lack of evidence from high-quality studies regarding the diagnostic process of functional somatic syndromes in primary care. Little is known about the barriers and difficulties that hinder general practitioners to implement evidence based recommendations and to correctly diagnose somatic symptom disorders. The aim of the qualitative part of this mixed-methods study is to analyse and concisely describe the diagnostic process that results in the diagnosis or non-diagnosis of a somatic symptom disorder in primary car. In addition, we aim to identify relevant barriers and difficulties which hinder the implementation of evidence based recommendations in the diagnostic process. The aim of the quantitative part is to quantify the identified barriers in a written survey given to general practitioners throughout Germany. Finally, based on the qualitative and quantitative results, solution approaches to improve the implementation of evidence based recommendations in the diagnostic process of somatic symptom disorders will be developed.