Unexplained symptoms in primary care: Perspectives of doctors and patients

This study evaluated unexplained symptoms in primary care from the perspect ive of both patients and physicians. The data were obtained from two 1998 s tatewide surveys, one targeting Medicaid patients and the other all primary care physicians in the state. There were 439 patients who responded (45% r esponse rate) and 280 primary care physicians who responded (33% response r ate). Half of the patients and half of the physicians were in non-metropoli tan counties. Half of the patients reported unexplained symptom usually or always, and 75% of whom sought help for these symptoms. Fifty-two per cent of these patients believed their physician was very concerned about their u nexplained symptoms. Eighty percent of them rated their physician as provid ing the best possible care compared to only 49% of patients whose physician did not care about their unexplained symptoms (P = .001). Among the physic ians, only 14% reported very good or excellent satisfaction with managing u nexplained symptoms as compared to 44% who claimed similar satisfaction in managing psychological problems. Physicians who saw themselves as more effe ctive ill dealing with somatoform symptoms were more likely to be in solo p ractice (P < .005), or in the same location for at least five years (P = .0 4). Residence in a nonmetropolitan county did riot affect patient reporting of symptoms, patient perception of physician concern about symptoms, or ph ysician satisfaction in managing these symptoms. These results indicate the prevalance and importance of unexplained symptoms in the Medicaid populati on and the comfort of physicians in managing these symptoms. There is an un met need among primary care physicians to learn how to manage patients with unexplained symptoms. (C) 2000 Elsevier Science Inc.