Explaining medically unexplained symptoms: Somatizing patients' responses in primary care

ObjectiveTo examine (1) how physicians present an explanation of symptoms in terms of a hormonal imbalance as a means to initiate a psychosocial discussion with somatizing patients; and (2) how they respond to this explanation of symptoms.MethodsQualitative study of 11 sequences in which physicians explain patients' symptoms in terms of a hormonal imbalance are micro-analyzed using Conversation Analysis.ResultsSymptom explanations (SEs) were vague, tentative, and uncertain. Two patterns of SEs (general vs. specific) and five different patterns of patient response were found. Patient responses are classified according to whether they occur during or after the SE, and according to the degree of work patients carry out to verbalize a response.ConclusionSymptom explanations elicited varying degrees of patient agreement, and allowed physicians to obtain patients' permission to conduct a psychosocial exploration.Practice implicationsPhysicians may start SEs by associating symptoms to a hormonal imbalance, and by relating them to universally recognizable emotions and familiar situations. Excessive emphasis on long and complex SEs and on seeking extended verbalizations of patient agreement may be counterproductive and antagonize the patient.