The British journal of general practice : the journal of the Royal College of General Practitioners
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Primary care guidelines for the management of persistent, often 'medically unexplained', physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions. However, many GPs experience difficulties in reaching a shared understanding with patients. ⋯ Patients describe different types of relations between physical symptoms and negative emotions in consultations. Physical symptoms can be attributed to emotions when patients introduce this link themselves, but this link tends to be denied when introduced by the GP. Awareness of the ways patients discuss these relations could help GPs to better understand the patient's view and, in this way, collaboratively move towards constructive explanations and symptom management strategies.
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It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this. ⋯ Most 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.
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Patient multimorbidity and GP burnout are increasing problems in primary care and are potentially related. ⋯ A high crude rate of patient physical multimorbidity increased the likelihood of burnout among GPs. The sex- and age-standardised rate of multimorbidity was not related to GPs' likelihood of burnout. Thus, the absolute amount of multimorbidity, and not the relative, affects the GP's burnout risk. GPs with high numbers of patients with complex needs should be supported to prevent suboptimal care and GP burnout.
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Antenatal vaccines are commonly delivered in primary care, yet the views of GPs regarding these programmes have been neglected in research to date. ⋯ There is support among GPs to embed vaccination programmes within routine antenatal care. Further educational resources, specifically designed for the needs of GPs, are needed to facilitate opportunistic discussion with pregnant women about vaccination.