A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Objective

To develop a taxonomy of explanations for patients with persistent physical symptoms.

Methods

We analysed doctors’ explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often “medically-unexplained,” physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations.

Results

We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts – generic statements about normal or dysfunctional processes; Causes – person-specific statements about proximal or distal causes for symptoms; Mechanisms – processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components.

Conclusions

This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency.

Practice implications

The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.

Abbreviations MUS, medically unexplained symptom(s); DSM, diagnostic and statistical manual of mental disorders; SCI, symptoms clinic intervention; GP, general practitioner; MSS1, multiple symptoms study 1; MSS2, multiple symptoms study 2; PHQ-15, patient health questionnaire 15