Medically unexplained symptoms as a threat to patients' identity?. A conversation analysis of patients' reactions to psychosomatic attributions

Patient Education and Counseling

Volumn 79, Issue 2, 2010, Pages 207-217

  Burbaum, Christina ^a   Stresing, Anne Maria ^b   Fritzsche, Kurt ^a   Auer, Peter ^b   Wirsching, Michael ^a   Lucius Hoene, Gabriele ^b  

^a UNIVERSITY OF FREIBURG   (Germany)

^b UNIVERSITY OF FREIBURG   (Germany)

Author keywords

Consultation and liaison service; Conversation analysis; Doctor patient communication; Medically unexplained symptoms; Reattribution; Somatization

Indexed keywords

ARTICLE; CLINICAL ARTICLE; CONSULTATION; CONTROLLED STUDY; CONVERSATION; DOCTOR PATIENT RELATION; HOSPITAL PATIENT; HUMAN; IDENTITY; LINGUISTICS; MEDICALLY UNEXPLAINED SYMPTOM; PATIENT CARE; PRIORITY JOURNAL; PSYCHOSOMATIC DISORDER; PSYCHOTHERAPIST; QUALITATIVE ANALYSIS;

ATTITUDE TO HEALTH; GERMANY; HUMANS; PHYSICIAN-PATIENT RELATIONS; PSYCHOLINGUISTICS; PSYCHOPHYSIOLOGIC DISORDERS; PSYCHOTHERAPY; REFERRAL AND CONSULTATION; SELF CONCEPT; SOMATOFORM DISORDERS;

EID: 77951977380     PISSN: 07383991     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.pec.2009.09.043     Document Type: Article

References (85)

1. Peveler R., Kilkenny L., Kinmonth A.L. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res 1997, 42:245-252.
2. Weijden T., van der Velsen M., van Dinant G.J., Hasselt C.M., van Grol R. Unexplained complaints in general practice: prevalence, patients' expectations, and professionals' test-ordering behavior. Med Decis Making 2003, 23:226-231.
3. Maiden N.L., Hurst N.P., Lochhead A., Carson A.J., Sharpe M. Medically unexplained symptoms in patients referred to a specialist rheumatology service: prevalence and associations. Rheumatology 2003, 42:108-112.
4. Nimnuan C., Hotopf M., Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res 2001, 51:361-367.
5. Reid S., Wessely S., Crayford T., Hotopf M. Medically unexplained symptoms in frequent attenders of secondary health care: retrospective cohort study. Br Med J 2001, 322:767.
6. Barsky A.J., Orav E.J., Bates D.W. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005, 62:903-910.
7. Barsky A.J., Ettner S.L., Horsky J., Bates D.W. Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care 2001, 39:705-715.
8. Fink P. Surgery and medical treatment in persistent somatizing patients. J Psychosom Res 1992, 36:439-447.
9. Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med 1992, 22:173-180.
10. Stanley I.M., Peters S., Salmon P. A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms. Int J Psychiatry Med 2002, 32:125-140.
11. Biderman A., Yeheskel A., Herman J. Somatic fixation: the harm of healing. Soc Sci Med 2003, 56:1135-1138.
12. Barsky A.J., Borus J.F. Functional somatic syndromes. Ann Intern Med 1999, 130:910-921.
13. Kouyanou K., Pither C.E., Rabe-Hesketh S., Wessely S. A comparative study of iatrogenesis, medication abuse, and psychiatric morbidity in chronic pain patients with and without medically explained symptoms. Pain 1998, 76:417-426.
14. Page L.A., Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. J R Soc Med 2003, 96:223-227.
15. Hartz A.J., Noyes R., Bentler S.E., Damiano P.C., Willard J.C., Momany E.T. Unexplained symptoms in primary care: perspectives of doctors and patients. Gen Hosp Psychiatry 2000, 22:144-152.
16. Chew-Graham C., May C. Chronic low back pain in general practice: the challenge of the consultation. Fam Pract 1999, 16:46-49.
17. Wileman L., May C., Chew-Graham C.A. Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Fam Pract 2002, 19:178-182.
18. Woivalin T., Krantz G., Mantyranta T., Ringsberg K.C. Medically unexplained symptoms: perceptions of physicians in primary health care. Fam Pract 2004, 21:199-203.
19. Salmon P., Peters S., Stanley I. Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. Br Med J 1999, 318:372-376.
20. Nettleton S., Watt I., O'Malley L., Duffey P. Understanding the narratives of people who live with medically unexplained illness. Patient Educ Couns 2005, 56:205-210.
21. Nettleton S. 'I just want permission to be ill': towards a sociology of medically unexplained symptoms. Soc Sci Med 2006, 62:1167-1178.
22. Werner A., Malterud K. It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Soc Sci Med 2003, 57:1409-1419.
23. Werner A., Isaksen L.W., Malterud K. 'I am not the kind of woman who complains of everything': illness stories on self and shame in women with chronic pain. Soc Sci Med 2004, 59:1035-1045.
24. Kenny D.T. Constructions of chronic pain in doctor-patient relationships: bridging the communication chasm. Patient Educ Couns 2004, 52:297-305.
25. Salmon P., Dowrick C.F., Ring A., Humphris G.M. Voiced but unheard agendas: qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners. Br J Gen Pract 2004, 54:171-176.
26. Ring A., Dowrick C., Humphris G., Salmon P. Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study. Br Med J 2004, 328:1057-1060.
27. Peters S., Stanley I., Rose M., Salmon P. Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care. Soc Sci Med 1998, 46:559-565.
28. Ring A., Dowrick C.F., Humphris G.M., Davies J., Salmon P. The somatising effect of clinical consultation: what patients and doctors say and do not say when patients present medically unexplained physical symptoms. Soc Sci Med 2005, 61:1505-1515.
29. Epstein R.M., Shields C.G., Meldrum S.C., Fiscella K., Carroll J., Carney P.A., Duberstein P.R. Physicians' responses to patients' medically unexplained symptoms. Psychosom Med 2006, 68:269-276.
30. Salmon P., Humphris G.M., Ring A., Davies J.C., Dowrick C.F. Why do primary care physicians propose medical care to patients with medically unexplained symptoms? A new method of sequence analysis to test theories of patient pressure. Psychosom Med 2006, 68:570-577.
31. Salmon P., Humphris G.M., Ring A., Davies J.C., Dowrick C.F. Primary care consultations about medically unexplained symptoms: patient presentations and doctor responses that influence the probability of somatic intervention. Psychosom Med 2007, 69:571-577.
32. Rhodes L.A., Phillips-Tangum C.A., Markham C., Klenk R. The power of the visible: the meaning of diagnostic tests in chronic back pain. Soc Sci Med 1999, 48:1189-1203.
33. Stresing AM. Somatoforme Patienten im psychotherapeutischen Gespräch. Eine konversationsanalytische Untersuchung zur interaktiven Bearbeitung eines psychosomatischen Krankheitsverständnisses. Dissertation an der Universität Freiburg; in press.
34. Schweickhardt A., Larisch A., Wirsching M., Fritzsche K. Short-term psychotherapeutic interventions for somatizing patients in the general hospital: a randomized controlled study. Psychother Psychosom 2007, 76:339-346.
35. Rief W., Hiller W., Heuser J. SOMS, screening for somatoform disorders-manual to the questionnaire (in German) 1997, Bern, Huber.
36. Goldberg D., Paul W. A user's guide to the general health questionnaire 1991, Windsor, Nfer-Nelson.
37. Goldberg D., Gask L., O'Dowd T. The treatment of somatization: teaching techniques of reattribution. J Psychosom Res 1989, 33:689-695.
38. Morriss R.K., Gask L., Ronalds C., Downes-Grainger E., Thompson H., Goldberg D. Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners. Br J Gen Pract 1999, 49:263-267.
39. Lamnek S. Qualitative Sozialforschung: Lehrbuch 2005, Beltz, Weinheim; Basel.
40. Denzin N.K., Lincoln Y.S. Handbook of qualitative research 2001, Sage, Thousand Oaks.
41. Murck K., Mey M. Qualitative Forschung: Zur Einführung in einen prosperierenden Wissenschaftszweig. Historical Social Res 2005, 30:5-27.
42. Sacks H., Schegloff E.A., Jefferson G. A simplest systematics for the organisation of turn-taking for conversation. Language 1974, 50:696-735.
43. Frankel R.M. From sentence to sequence: understanding the medical encounter through micro-interactional analysis. Discourse Process 1984, 7:135-170.
44. Gill V.T. Doing attributions in medical interaction: patients' explanations for illness and doctors' responses. Soc Psych Quart 1998, 61:342-360.
45. Heritage J., Maynard D.W. Communication in medical care. Interaction between primary care physicians and patients 2006, Cambridge University Press, Cambridge.
46. Robinson J.D. Asymmetry in action: sequential resources in the negotiation of a prescription request. Text 2001, 21:19-54. [Special Issue: Lay Diagnosis].
47. Stivers T. " Symptoms Only" and " Candidate Diagnoses": presenting the problem in paediatric encounters. Health Commun 2002, 14:299-338.
48. ten Have P. The consultation as a genre. Text and talk as social practice 1989, 115-135. Foris Publications, Dordrecht. B. Torode (Ed.).
49. Antaki C., Barnes R., Leudar I. Trouble in agreeing on a client's problem in a cognitive-behavioural therapy session. Rivista di Psicolinguistica Applicata 2004, 4:127-138.
50. Bergmann J. Veiled morality: notes on discretion in psychiatry. Talk at work 1992, 137-162. Cambridge University Press, Cambridge. P. Drew, J. Heritage (Eds.).
51. Buttny R. Clients' and therapist's joint construction of the clients' problems. Res Language Social Interact 1996, 29:125-153.
52. Peräkylä A. Making links in psychoanalytic interpretations: a conversation analytic view. Psychother Res 2004, 14:289-307.
53. Conversation analysis and psychotherapy 2008, Cambridge University Press, Cambridge. A. Peräkylä, C. Antaki, S. Vehviläinen, I. Leudar (Eds.).
54. Vehviläinen S. Preparing and delivering interpretations in psychoanalytic interaction. TEXT 2003, 23:573-606.
55. Auer P. Sprachliche Interaktion: Eine Einführung anhand von 22 Klassikern 1999, Niemeyer, Tübingen.
56. Hollway W. Gender difference and the production of subjectivity. Changing the subject. Psychology, social regulation and subjectivity 1984, 227-263. Methuen, London. J. Henrique, W. Hollway, C. Urwin, C. Venn, V. Walkerdine (Eds.).
57. Positioning theory: moral contexts of intentional action 1999, Blackwell, Oxford. R. Harré, L. van Langhove (Eds.).
58. Bamberg M. Positioning between structure and performance. J Narrative Life History 1997, 7:335-342.
59. Bamberg M. Is there anything behind discourse? Narrative and the local accomplishment of identities. Challenges to theoretical psychology 1999, 220-227. Captus University Publications, North York. W. Maiers, B. Bayer, D. Esgalhado, R. Jorna, E. Schraube (Eds.).
60. Wortham S. Interactional positioning and narrative self-construction. Narrative Inquiry 2000, 10:157-184.
61. Wortham S. Narratives in action. A strategy for research and analysis 2001, Teachers College Press, New York.
62. Lucius-Hoene G., Deppermann A. Rekonstruktion narrativer Identität. Ein Arbeitsbuch zur Analyse narrativer Interviews 2002, Leske & Budrich, Opladen.
63. Lucius-Hoene G., Deppermann A. Narrative identity empiricized. A dialogical and positioning approach to autobiographical research interviews. Narrative Inquiry 2000, 10:199-222.
64. Antaki C., Widdicombe S. Identities in talk 1998, Sage, London.
65. Hutchby I., Wooffitt R. Conversation analysis 2008, Polity Press, Oxford. 2nd ed.
66. Liddicoat A.J. An introduction to conversation analysis 2007, Continuum, London.
67. Selting M., Auer P., Barden B., Bergmann J., Couper-Kuhlen E., Günthner S., Meier Ch, et al. Gesprächsanalytisches Transkriptionssystem (GAT). Linguistische Berichte 1998, 173:91-122.
68. Jefferson G. List-construction as a task and a resource. Interaction competence 1990, 63-92. University Press of America, Washington, DC. G. Psathas (Ed.).
69. Stresing A. Die Entwicklung des Krankheitsverständnisses im therapeutischen Gespräch: eine konversationsanalytische Untersuchung (Magisterarbeit); 2006. http://www.freidok.uni-freiburg.de/volltexte/2403/pdf/Magisterarbeit_Die_Entwicklung.pdf.
70. Bercelli F, Viaro M, Rossano F. Intersession 'Recallings' in psychotherapy. http://www-utenti.dsc.unibo.it/~bercelli/articoli_on_line/cardiff-1.htm.
71. Günther S. Polyphony and the layering of voices in reported dialogues. J Pragm 1999, 31:685-708.
72. Peräkylä A. Patients' responses to interpretations. A dialogue between conversation analysis and psychoanalytic theory. Commun Med 2005, 2:163-176.
73. Salmon P. Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Educ Couns 2007, 67:246-254.
74. Salmon P., Peters S., Clifford R., Iredale W., Gask L., Rogers A., Dowrick C., Hughes J., Morriss R. Why do general practitioners decline training to improve management of medically unexplained symptoms?. J Gen Intern Med 2007, 22:565-571.
75. Larisch A., Schweickhardt A., Wirsching M., Fritzsche K. Psychosocial interventions for somatizing patients by the general practitioner: a randomized controlled trial. J Psychosom Res 2004, 57:507-514.
76. Morriss R., Dowrick C., Salmon P., Peters S., Dunn G., Rogers A., Lewis B., Charles-Jones H., Hogg J., Clifford R., Rigby C., Gask L. Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. Br J Psychiatry 2007, 191:536-542.
77. Rosendal M., Olesen F., Fink P., Toft T., Sokolowski I., Bro F. A randomized controlled trial of brief training in the assessment and treatment of somatisation in primary care: effects on patient outcome. Gen Hosp Psych 2007, 29:364-373.
78. Dowrick C., Gask L., Hughes J.G., Huw Charles-Jones H., Hogg J.A., Peters S., Salmon P., Rogers A.R., Morriss R. General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study. BMC Fam Pract 2008, 9:46.
79. Goffman E. Stigma: notes on the management of spoilt identity 1963, Prentice Hall, New York.
80. Henningsen P., Priebe S. Modern disorders of vitality: the struggle for legitimate incapacity. J Psychosom Res 1999, 46:209-214.
81. Stresing AM, Burbaum C. " Und wenn die jetzt nix Organisches richtig finden würden?" Befürchtungen von Patienten mit körperlichen Beschwerden ohne Organbefund; in preparation.
82. Schäfert R., Bölter R., Faber R., Kaufmann C. Tangential, nicht frontal. Annäherung an eine schwierige Patientengruppe. PID 2003, 9:252-259.
83. Smith R.C., Lein C., Collins C., Lyles J.S., Given B., Dwamena F.C., Coffey J., Hodges A., Gardiner J.C., Goddeeris J., Given C.W. Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med 2003, 18:478-489.
84. Smith R.C., Lyles J.S., Gardiner J.C., Sirbu C., Hodeges A., Collings C., Dwamena F.C., Lein C., Given W., Given B., Goddeeris J. Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. J Gen Intern Med 2006, 21:671-677.
85. Creed F., Guthrie E. Techniques for interviewing the somatising patient. Br J Psychiatry 1993, 162:467-471.