Psychosocial explanations of complaints in Dutch general practice

Abstract

Background. Dutch GPs are frequently consulted by patients presenting physical complaints which have a psychosocial cause. Until now, this type of complaint has often been the subject of study, but the way in which psychosocial explanations for complaints are broached and discussed has not yet been studied. Objective. We aimed to analyse the way in which GPs and patients relate physical complaints to psychosocial causes and whether this affects the advice or treatment given in the course of the consultation. We hoped to provide insight into the actual behaviour of GPs and patients concerning these issues. Method. From a corpus of 279 videotaped consultations, 24 consultations of eight GPs, four female and four male in different practices, were selected for analysis. The verbal behaviour of GPs and patients in the selected consultations was transcribed in detail and subsequently analysed, according to the qualitative methodology of conversation analysis. Results. Patients present explicit, as well as implicit, psychosocial explanations. GPs respond confirmatively to the first kind and almost ignore the latter. GPs present two types of psychosocial cause-seeking questions. Verifying questions suggesting a psychosocial cause lead to an explicit response from patients; conversely, exploratory queries investigating potential psychosocial causes lead always to a denial. Subsequently, GPs initiate a checklist strategy to investigate potential psychosocial causes. This strategy hardly ever leads to establishing a psychosocial explanation. GPs nearly always focus on the somatic aspects of the complaint, notwithstanding the establishment of a psychosocial explanation. They will hardly ever give any psychosocial advice in the course of that same consultation. Conclusion. GPs and patients are cautious in relating physical complaints with psychosocial causes. Psychosocial explanations are formulated and treated as delicate activities in the context of the consultation. GPs and patients both contribute to psychosocial explanations, but GPs contribute more to this delicate topic than their patients do.