Medically unexplained physical symptoms – challenges and strategies in primary health care

Evaluation of «Independent medical evaluation»

In this project, we search to find out whether an independent medical evaluation (IME) results in faster return to work (RTW) among long-term sick listed patients compared to usual follow-up from the patients´ regular GPs. Senior researcher Aase Aamland has the responsibility for the qualitative part of the evaluation. Expectations about and experiences with IMEs are collected and analysed among participating GPs, patients and IME-doctors.

Project leader is Silje Mæland (Stress, health and rehabilitation), and research team members are Irene Øyeflaten (Stress, health and rehabilitation), Elisabeth Husabø (Stress, health and rehabilitation) and Aase Aamland (AFE)

Funding: This project is funded by The Norwegian Labour and Welfare Administration

Procject period Spring 2015 – Winter 2018

Helpful strategies for GPs seeing patients with medically unexplained physical symptoms

The aim was to explore GPs´ experiences about strategies perceived as helpful when seeing patients with MUPS. We performed three focus group discussions with a purposive sample of 24 experienced GPs in Norway. Several strategies were experienced as helpful in consultations with patients with MUPS. 1) A comprehensive outline of the medical past and present could serve as foundation of the dialogue. Reviewing the patient record and sharing relevant information with the patient or conducting a thorough clinical examination could offer golden moments of trust and common understanding. 2) Very concrete exchange of symptom and diagnosis interpretation sometimes created space for explanations and action, and confrontations might even strengthen the alliance. 3) Bypassing conventional answers and transcending tensions by negotiating innovative explanations could help patients sort out symptoms and establish creative comprehension. Yet, GPs use tangible, down-to-earth strategies in MUPS consultations, and sharing such strategies with colleagues within a field where frustration and dissatisfaction abundantly occur, can encourage GPs to develop sustainable responsibility and innovative solutions.

Procject leader Aase Aamland (AFE). Research team members: Anette Fosse (AFE), Eline Ree (Stress, health and rehabilitation), Eirik Abildsnes (Department of Global Public Health and Primary Care, University of Bergen) and Kirsti Malterud (AFE).

Funding: This project was funded by Eckbos Legat, Norway

Project period: November 2015 – July 2017

Medically unexplained physical symptoms and sick leave

The objective of this project was to develop new knowledge on MUPS and sick leave, with a special focus on the GP´s role. We conducted three empirical sub-studies based on the following aims: 1) What does the existing literature say about phenomena associated with sick leave among patients with MUPS? 2) What is the consultation prevalence, symptom pattern, employment status and the GPs’ management strategies for patients with persistent MUPS in Norwegian general practice? and 3) What kind of experiences related to marginalization do patients with MUPS present after being long-term sick leave? The studies had the following main findings: Patients with persistent MUPS constitute one of the most common patient groups in Norwegian general practice. The GPs may hold an important supportive role for patients with MUPS on long-term sick leave. This may in turn counteract further marginalization. Yet, no interventions in general practice have shown to reduce sick leave. There are both similarities and diversities among patients with MUPS regarding demographics, psychiatric comorbidity and employment status. The GPs’ most common management strategy for patients with MUPS is supportive counselling.

These results were the foundation of the thesis «Medisinsk uforklarte plager og symptomer og sykefravær – Allmennlegens rolle». Aamlands doctoral dissertation was held in January 2015 in Bergen. The main supervisor was Erik L. Werner and Kirsti Malterud was co-supervisor.

Funding: The Norwegian General Practice Research Fund for General Practice funded the project.

Ph.D.-period: August 2010 – December 2014

Updated: 12.10.18