Treating medically unexplained disorders: experiences of general practitioners

Apie 50 proc. visų pirminės sveikatos priežiūros pacientų skundų sudaro skundai dėl negalavimų, kurių patologijos nepavyksta nustatyti tyrimais (Nettleton, 2006; Wileman, 2002; Asmundson, 2001). Šeimos gydytojams tenka svarbiausias vaidmuo dirbant su šiais sveikatos sutrikimais. Straipsnyje aptariamos gydytojų patirtys ir konsultavimo prieigos, kurias jie taiko dirbdami su pacientais, besiskundžiančiais mediciniškai nepaaiškinamais negalavimais (MNN). Susidūrę su MNN atvejais gydytojai remiasi skirtingomis paciento konsultavimo prieigomis: biomedicinine, psichologine ir biopsichosocialine. Prieigos taikymas siejasi su tuo, kaip gydytojas aiškina MNN kilmę, tai priklauso ir nuo paciento poreikių. Gydytojai mano, kad darbas su tokiais sutrikimais kaip MNN peržengia šeimos gydytojo kompetencijos ribas, todėl su tokiais pacientais turėtų dirbti kiti specialistai50% of all primary health care patients present persistent symptoms without clear pathology (Nettleton 2006; Wileman 2002; Asmundson 2001). In medical practice these symptoms are referred to as medically unexplained disorders. Family doctors play most significant role in management of patients with such disorders. However, since there is no clear medical consensus regarding etiology, classification, diagnosis and treatment of medically unexplained disorders, family doctors have to develop their own strategies of examining, consulting and treating their patients. Using data from semi-structured interviews with 17 family doctors working in Kaunas and Kaunas region, this article describes main medical consulting approaches used by family doctors when managing patients with medically unexplained disorders. The findings of the study indicate that family doctors use three different approaches in managing medically unexplained cases: biomedical, psychological and psychosocial. The use of a particular medical consulting aproach depends on a doctor’s perception of the etiology of disorder and patient’s expectations. While family doctors tend to switch between different consulting approaches depending on concrete case and individual patient’s perception of his or her health problem, the biomedical approach seems to be a dominant consulting approach. Some doctors claim that since medically unexplained disorders are of social nature they should be managed by using non-medical approaches and by non-medical specialistsLietuvos sveikatos mokslų universitetasSociologijos katedraVytauto Didžiojo universiteta