The treatment of somatization: Evaluation of a teaching package with general practice trainees

doi:10.1016/0022-3999(89)90085-8

Journal of Psychosomatic Research

Volume 33, Issue 6, 1989, Pages 697-703

https://doi.org/10.1016/0022-3999(89)90085-8 Get rights and content

Abstract

A teaching package is described which aims to improve the management of somatization by general practice trainees. The package comprises a training videotape in which a model (described in the preceding paper) is demonstrated, together with material for paired role-play of new skills and small group videofeedback of consultations. Evaluation of the teaching package reveals that the skills can be effectively learned.

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Cited by (79)

Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings
2011, Journal of Psychosomatic Research
Citation Excerpt :
A further 3 relevant research papers and 2 unpublished theses were added from searching of reference lists and the personal contacts/knowledge of the research team giving a total of 25 papers (Fig. 1). These resulted from 13 different studies utilising the Reattribution model carried out in the United Kingdom (UK) [8–12,22–27,30,31], the Netherlands [13,14,28], Denmark [15–20], Germany [21,32,33], and Spain [29] since 1989. The main quantitative findings are summarised in Table 1.
Medically unexplained symptoms (MUS) refer to bodily symptoms without a physical health explanation. In the context of MUS, reattribution is a process of attributing physical symptoms to a psychological cause. We review the use of a consultation model which employs reattribution, and which has been extensively utilised in teaching and research in primary care.
Literature search for studies utilising the reattribution model. Narrative review of the results.
Data was extracted from 25 publications from 13 studies. The model has been modified over time and comparison between studies is limited by differences in methodology. The skills of the model can be acquired by training, which also improves practitioners' attitudes to MUS. However impact on clinical outcomes has been mixed and this can be explained in part from the findings of nested qualitative studies.
The reattribution model is too simplistic in its current form to address the needs of many people presenting with MUS in primary care. Reattribution of physical symptoms to psychological causes is often unnecessary. Further research is required into the effectiveness of stepped and collaborative care models in which education of primary care practitioners forms one part of a complex intervention. The consultation process is best seen as both a conversation and ongoing negotiation between doctor and patient in which there are no certainties about the presence or absence of organic pathology.
Evaluation of general practitioners' training: How to manage patients with unexplained physical symptoms
2006, Psychosomatics
Patients with unexplained physical symptoms (“somatoform disorders”) tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.
Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (the MUST)
2006, General Hospital Psychiatry
The evidence for the effectiveness of reattribution training are limited, and optimal service delivery is not yet established.
The objectives of this study were to establish the feasibility and to optimize the service delivery and design of a definitive randomized controlled trial (RCT) of reattribution training for patients with medically unexplained symptoms (MUSs) in routine primary care.
The study was of a cluster RCT design with the practice as the unit of randomization. Health facilitator (HF)-delivered reattribution training was compared with no reattribution training. The primary outcome measure used is doctor–patient communication in the consultation. Quantitative and qualitative methods identify barriers to effectiveness. The acceptability and feasibility of the intervention were established by attendance rates and postal survey after completion of training.
Sixteen practices and 70 family practitioners (FPs) were recruited with representative practice and FP characteristics. Six hours of HF reattribution training to FPs in the workplace proved feasible and acceptable with all 35 FPs completing the training. Feedback from 27 (77%) FPs who received training indicated that 25 (93%) FPs believed that specific and relevant learning achievements were made, 22 (82%) felt more confident and 21 (77%) thought the training was useful.
HF-delivered reattribution training to whole practices is feasible and acceptable, and its effectiveness is measurable in routine primary care.
Why do doctors feel pressurized?
2005, Journal of Psychosomatic Research
Structured communication methods for mental health consultations in primary care: a scoping review
2023, BMC Primary Care
Behavioural modification interventions for medically unexplained symptoms in primary care: Systematic reviews and economic evaluation
2020, Health Technology Assessment

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The treatment of somatization: Evaluation of a teaching package with general practice trainees

Abstract

J psychosom Res

Lancet

Soc Sci & Med

J psychosom Res

Gen Hosp Psychiat

Evaluating the teaching of a method of psychotherapy

Br J Psychiat