A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Lakrista Morton, Alison Elliott, Jennifer Cleland, Vincent Deary, Christopher Burton

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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.
Original languageEnglish
Pages (from-to)224–230
Number of pages7
JournalPatient Education and Counseling
Volume100
Issue number2
Early online date17 Aug 2016
DOIs
Publication statusPublished - 1 Feb 2017

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General Practitioners
Referral and Consultation
Medically Unexplained Symptoms

Keywords

  • medically unexplained symptoms
  • somatoform disorders
  • explanation
  • reassurance
  • primary care

Cite this

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title = "A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms",
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. Thesediffered 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. Mostexplanations 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.",
keywords = "medically unexplained symptoms, somatoform disorders, explanation , reassurance, primary care",
author = "Lakrista Morton and Alison Elliott and Jennifer Cleland and Vincent Deary and Christopher Burton",
note = "MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies.",
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AU - Morton, Lakrista

AU - Elliott, Alison

AU - Cleland, Jennifer

AU - Deary, Vincent

AU - Burton, Christopher

N1 - MSS1 and MSS2 were supported by grants from the Chief Scientist Office of the Scottish Government (references CZG/2/412 and CZH/4/945). We are grateful to the general practitioners and patients who participated in these studies.

PY - 2017/2/1

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N2 - 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. Thesediffered 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. Mostexplanations 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.

AB - 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. Thesediffered 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. Mostexplanations 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.

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KW - reassurance

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