چکیده (انگلیسی):

Background:Patients with medically unexplained symptoms (MUS) commonly present in general practice. They
often experience significant disability and have difficulty accessing appropriate care. Many feel frustrated and
helpless. Doctors also describe feeling frustrated and helpless when managing these patients. These shared
negative feelings can have a detrimental effect on the therapeutic relationship and on clinical outcomes. The aim
of this study was to explore how novice and experienced GPs manage patients with MUS and how these skills are
taught and learned in GP training.
Methods:A constructivist grounded theory study with 24 general practice registrars and supervisors in GP training
practices across Australia.
Results:Registrars lacked a framework for managing patients with MUS. Some described negative feelings towards
patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where
their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the
practical, interpersonal and therapeutic challenges associated with the care of these patients.
Conclusions:Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from
managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness,
are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings
so that consultations are more effective. The care of these patients also raises issues of professional identity, roles
and responsibilities. Supervisors can assist their registrars by proactively sharing models of the consultation,
strategies for managing their own feelings and frustrations, and ways of understanding and managing the
therapeutic relationship in this difficult area of practice.