Somatisation in primary care: clinical judgement and standardised measurement compared

Background: In daily practice general practitioners (GPs) generally rely on their clinical judgement in assessing whether patients somatise distress. Nevertheless. conclusions derived from research on somatisation in primary care are largely based on standardised measurements of somatisation. We inv estigated the relation between GPs' clinical judgement of somatisation and a somatisation research instrument (DSM-III-R), and examined how both opera tionalisations of somatisation related to other important variables. Method s: In nine general practices, 407 frequently attending patients answered a questionnaire on somatisation symptoms, while the GPs gave their judgement on somatisation and communication for each patient. Other variables were ex tracted from the registered health status of the patients. Results: We foun d a weak association (correlation: 0.27) between the GPs' judgement and the research instrument; however, relations with other variables showed that b oth operationalisations were very similar constructs. The research instrume nt incorporated more psychological problems (depression and anxiety), while the GPs' judgement of somatisation was more influenced by attendance rate and by aspects of communication with the patient. Conclusion: For research addressing somatisation in primary care as a practical clinical problem. th e operationalisation of somatisation should include the clinical judgement of the practitioner as well, thereby widening the focus from co-morbid ment al disturbances to communication aspects.