• Juul Houwen, Peter Lbj Lucassen, Stijn Dongelmans, Hugo W Stappers, Willem Jj Assendelft, Sandra van Dulmen, and Tim C Olde Hartman.
• Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
• Br J Gen Pract. 2020 Feb 1; 70 (691): e86-e94.

BackgroundIt is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.AimTo establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.Design And SettingThis was a qualitative study. Data were collected in the Netherlands in 2015.MethodGPs' consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.ResultsA total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.ConclusionMost GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients' symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.© British Journal of General Practice 2020.

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