BACKGROUND Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs' difficulties in communication during MUS consultations. METHODS We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication. RESULTS Twenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs' communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient's story, the quality of the contact and sharing decisions). Analysis of the patients' views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n = 42) the patients' comments were positive. The video-recorded transcripts (n = 9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient). CONCLUSION GPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient).

中文翻译：

---

全科医生在与不明原因症状的患者会诊时遇到哪些困难：一项定性研究。

背景技术许多全科医生（GP）在与患有医学上无法解释的症状（MUS）的患者进行沟通时遇到困难。本研究旨在找出全科医生在 MUS 会诊期间的沟通困难。方法 我们对咨询进行了录像，并在咨询后立即询问全科医生是否出现了 MUS。然后，全科医生和患者被要求在观看咨询的同时，通过半结构化访谈分别反思咨询情况。我们选取了全科医生遇到困难或表示他们应该做其他事情的评论，并根据不断比较分析的原则对这些评论进行定性分析。接下来，我们选择了那些患者也经历过困难的视频记录；我们对这些进行了分析，以找出医患沟通中的问题。结果 20 名全科医生参与其中，其中两人未发现任何 MUS 咨询。18 位全科医生对 39 次 MUS 咨询发表了评论。在11次咨询中，全科医生没有遇到任何困难。在剩下的28次咨询中，全科医生针对他们遇到困难的60个片段提出了84条意见。我们确定了全科医生沟通中需要改进的三个问题：心理社会探索、咨询结构（更多关注总结、共享议程设置）和以人为本（更多关注预约原因、患者的故事、咨询质量）。联系和分享决定）。对患者对全科医生遇到困难的片段的看法的分析表明，在大多数片段（n = 42）中，患者的评论是积极的。患者也遇到问题的视频记录笔录（n = 9）的特点是缺乏对话（全科医生正在探索他/她自己的概念，提出封闭式问题并打断患者）。结论 全科医生意识到良好沟通的重要性。他们表示，通过更多地关注社会心理探索、咨询结构以及以更以人为本的方式进行沟通，他们可以进一步改善沟通。患者也遇到问题的笔录的特点是缺乏对话（专注于他/她自己的概念，提出封闭式问题并经常打断患者）。