What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized?

OBJECTIVE: We tested predictions that patients with medically unexplained symptoms (MUS) want more emotional support and explanation from their general practitioners (GPs) than do other patients, and that doctors find them more controlling because of this.

DESIGN: Thirty-five doctors participated in a cross-sectional comparison of case-matched groups. Three hundred fifty-seven patients attending consecutively with MUS were matched for doctor and time of attendance with 357 attending with explained symptoms. Patients self-reported the extent to which they wanted somatic intervention, emotional support, explanation and reassurance. Doctors rated their perception of patients' influence on the consultation. Predictions were tested by multilevel analyses.

RESULTS: Patients with MUS sought more emotional support than did others, but no more explanation and reassurance or somatic intervention. A minority of doctors experienced them as exerting more influence than others. The experience of patient influence was related to the patients' desire for support.

CONCLUSIONS: Future research should examine why GPs provide disproportionate levels of somatic intervention to patients who seek, instead, greater levels of emotional support.