Original Article

Physician Satisfaction in Treating Medically Unexplained Symptoms

Authors: Simon G. Brauer, MA, John D. Yoon, MD, Farr A. Curlin, MD

Abstract

Objectives: To determine whether treating conditions having medically unexplained symptoms is associated with lower physician satisfaction and higher ascribed patient responsibility, and to determine whether higher ascribed patient responsibility is associated with lower physician satisfaction in treating a given condition.

Methods: We surveyed a nationally representative sample of 1504 US primary care physicians. Respondents were asked how responsible patients are for two conditions with more-developed medical explanations (depression and anxiety) and two conditions with less-developed medical explanations (chronic back pain and fibromyalgia), and how much satisfaction they experienced in treating each condition. We used Wald tests to compare mean satisfaction and ascribed patient responsibility between medically explained conditions and medically unexplained conditions. We conducted single-level and multilevel ordinal logistic models to test the relation between ascribed patient responsibility and physician satisfaction.

Results: Treating medically unexplained conditions elicited less satisfaction than treating medically explained conditions (Wald P < 0.001). Physicians attribute significantly more patient responsibility to the former (Wald P < 0.005), although the magnitude of the difference is small. Across all four conditions, physicians reported experiencing less satisfaction when treating symptoms that result from choices for which patients are responsible (multilevel odds ratio 0.57, P = 0.000).

Conclusions: Physicians experience less satisfaction in treating conditions characterized by medically unexplained conditions and in treating conditions for which they believe the patient is responsible.

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References

1. Martell BA, O'Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med 2007;146:116-127.
 
2. Wolfe F. Fibromyalgia wars. J Rheumatol 2009;36:671-678.
 
3. May C, Doyle H, Chew-Graham C. Medical knowledge and the intractable patient: the case of chronic low back pain. Soc Sci Med 1999;48:523-534.
 
4. Sykes R. Medically unexplained symptoms and the siren “ inference.” Philos Psychiatry Psychol 2010;17:289-299.
 
5. Sharpe M, Carson A. “Unexplained” somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med 2001;134(9 Pt 2):926-930.
 
6. Nicholas MK, Wilson PH, Goyen J. Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain. Pain 1992;48:339-347.
 
7. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292:2388-2395.
 
8. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain 1992;49:221-230.
 
9. Jutel A. Sociology of diagnosis: a preliminary review. Sociol Health Illn 2009;31:278-299.
 
10. May C, Allison G, Chapple A, et al. Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners’ accounts. Sociol Health Illn 2004;26:135-158.
 
11. Peveler R, Kilkenny L, Kinmonth AL. Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res 1997;42:245-252.
 
12. Katon W, Kleinman A, Rosen G. Depression and somatization: a review: part I. Am J Med 1982;72:127-135.
 
13. Glenton C. Chronic back pain sufferers-striving for the sick role. Soc Sci Med 2003;57:2243-2252.
 
14. Fair B. Morgellons: contested illness, diagnostic compromise and medicalisation. Sociol Health Illn 2010;32:597-612.
 
15. Klø ME, Hess S. Understanding the formation and influence of attitudes in patients’ treatment choices for lower back pain: testing the benefits of a hybrid choice model approach. Soc Sci Med 2014;114:138-150.
 
16. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC:American Psychiatric Association;2013.
 
17. Katz J, Rosenbloom BN, Fashler S. Chronic pain, psychopathology, and DSM-5 somatic symptom disorder. Can J Psychiatry 2015;60:160-167.
 
18. Wolfe F, Walitt BT, Katz RS, et al. Symptoms, the nature of fibromyalgia, and diagnostic and statistical manual 5 (DSM-5) defined mental illness in patients with rheumatoid arthritis and fibromyalgia. PLoS One 2014;9:e88740.
 
19. Center for Health and the Social Sciences and the Maclean Center for Clinical Medical Ethics at the University of Chicago. Religion, spirituality, and common mental health concerns: a national physician survey. https://pmr.uchicago.edu/sites/pmr.uchicago.edu/files/uploads/Psych.pdf. Accessed February 21, 2017.
 
20. Lauderdale DS. Birth outcomes for Arabic-named women in California before and after September 11. Demography 2006;43:185-201.
 
21. Lauderdale DS, Kestenbaum B. Asian American ethnic identification by surname. Popul Res Policy Rev 2000;19:283-300.
 
22. Sheskin IM. A methodology for examining the changing size and spatial distribution of a Jewish population: a Miami case study. Shofar An Interdiscip J Jewish Stud 1998;17:97-116.