GENERAL-PRACTITIONERS ATTRIBUTIONS OF FATIGUE

In this paper general practitioners' (GPs') somatic-psychosocial attri butions of fatigue are examined. The attribution process during medica l consultations was studied by relating the GPs' judgements of the som atic-psychosocial character of their patients' fatigue to patient-rela ted characteristics, on the one hand, and medical-consultation charact eristics on the other hand. The study was based on 2097 contact regist rations from the Dutch National Study of Morbidity and Intervention in General Practice by the NIVEL (Netherlands institute of Primary Healt h Care). In order to explain the GPs' attributions, patient-related ch aracteristics were added stepwise in a multiple regression analysis. S ociodemographic characteristics explained only 1.8% of the variance. O ther complaints explained an additional 14.3% with psychosocial compla ints being most influential. Knowledge of an underlying disease/proble m explained an additional 9.9% of the variance. All of the characteris tics together explained 26.0% of the attributions by the GPs. More psy chosocially-attributed Fatigue was found to correlate with consultatio ns characterized by less physical examination, more diagnostic procedu res to reassure, Fewer diagnostic procedures to discover underlying pa thology, more counselling, less medical treatment, less prescription a nd a longer duration than consultations with more somatically attribut ed fatigue. It is concluded that GPs do not discriminate between socia l groups when attributing fatigue to either somatic or psychosocial ca uses. The presence and character of other complaints and underlying di seases/problems, rather, relate to the GPs' somatic-psychosocial attri butions, which are then associated with particular aspects of the cons ultation. (C) 1998 Elsevier Science Ltd. All rights reserved.