A taxonomy of explanations in a general practitioner clinic for patients with persistent "medically unexplained" physical symptoms. Issue 2 (February 2017)

• Record Type: Journal Article
• Authors: Morton, LaKrista; Elliott, Alison; Cleland, Jennifer; Deary, Vincent; Burton, Christopher
• Is Part Of: Patient education and counseling. Volume 100:Issue 2(2017)
• Page Start: 224
• Page End: 230
• Publication Date: 2017-02
• Subjects: MUS medically unexplained symptom(s) -- DSM diagnostic and statistical manual of mental disorders -- SCI symptoms clinic intervention -- GP general practitioner -- MSS1 multiple symptoms study 1 -- MSS2 multiple symptoms study 2 -- PHQ-15 patient health questionnaire 15; Medically unexplained symptoms -- Somatoform disorders -- Explanation -- Reassurance -- Primary care; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2016.08.015
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Explaining persistent "medically unexplained" symptoms to patients is difficult. A new taxonomy describes symptom explanations by type and content. Different types of explanation carry different implications for patients. This taxonomy provides a template for developing and testing explanations. Abstract: Objective: To develop a taxonomy of explanations for patients with persistent physical symptoms. Methods: We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained, " physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. Results: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts – generic statements about normal or dysfunctional processes; Causes – person-specific statements about proximal or distal causes for symptoms; Mechanisms – processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components . Conclusions: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency. Practice implications: The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.