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      A qualitative exploration of GPs’ perspectives on managing chronic nonspecific musculoskeletal pain in Australian general practice – a focus group study

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          Abstract

          Objective: Chronic nonspecific musculoskeletal pain (CNMP) is a complex idiopathic condition that causes significant disruption to patients’ lives, their relationships, and functionality. The cause of CNMP is not fully understood, which makes diagnosis and management challenging. As general practitioners (GPs) are central to the management of chronic pain, their perspectives on managing CNMP are important.

          Purpose: To explore the clinical reasoning GPs use when diagnosing and managing CNMP.

          Methods: A qualitative study design using focus group discussion was conducted with Australian GPs. Five focus group discussion were conducted across Adelaide. All focus group discussions were audio-recorded, and transcripts were coded and analyzed thematically with the program NVivo.

          Results: The main themes remained consistent across the five focus group discussion’s: the ambiguous cause of CNMP; sex differences; developing the “right strategy”; patient-centered care; and verifying vitamin D levels.

          Conclusion: The findings show that GPs use a patient-centered approach tailored to individual patients’ medical history, physical examination findings, and psychosocial health. There was general concern about low levels of vitamin D in patients with CNMP, and vitamin D supplements were recommended if indicated by a patient’s history.

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          Most cited references 20

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          Chronic pain in Australia: a prevalence study

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            Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

            Background Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. Methods A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. Results GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. Conclusion GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions.
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              The doctor/patient relationship and its effect upon outcome.

              The study of 299 chronically ill patients examined the doctor/patient relationship by asking two questions: first, what factors affect the quality of the relationship and secondly, does the doctor/patient relationship affect outcome for the patient? The doctor/patient relationship was measured by indicators of the doctor's awareness of the patient's problems.The following factors were found to be positively associated with the doctor's awareness: a small number of patient problems, a large number of recent visits, and the patient, rather than the doctor, initiating the consultation. The patient's age and education, the completeness of family care, and duration of care were not found to influence awareness. After eliminating the effect of confounding variables, the relationship between the doctor's awareness and the patient's recovery was maintained for some groups of patients. Awareness did not significantly affect the patient's satisfaction. We list some practical recommendations to aid doctors in increasing their knowledge of their patients.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                February 2018
                February 2018
                : 6
                : 1
                : 32-38
                Affiliations
                1Discipline of General Practice, The University of Adelaide, Adelaide, SA, Australia
                2Health Sciences Building (2.27), Flinders University, Adelaide, SA, Australia
                Author notes
                CORRESPONDING AUTHOR: Manasi Gaikwad, Discipline of General Practice, University of Adelaide, 178 North Terrace, Level 11, Adelaide, SA 5006, Australia, E-mail: manasi.gaikwad@ 123456adelaide.edu.au
                Article
                FMCH.2017.0125
                10.15212/FMCH.2017.0125
                Copyright © 2018 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Product
                Self URI (journal page): http://fmch-journal.org/
                Categories
                Qualitative Exploration

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