Characteristics of Illness Attribution and Doctor-patient Relationship of Patients with Multiple Somatic Symptoms in Outpatient Clinics of a General Hospital

  Objective  To explore the illness attribution of patients with multiple somatic symptoms and their relationship with doctors.

  Methods  This cross-sectional study was conducted from March to October, 2012, involving 150 participants who were recruited through convenience sampling from the outpatient clinics of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine of Peking Union Medical College Hospital. Based on somatic symptom scale of the patient health questionnaire (PHQ-15), the patients were divided into multiple somatic symptoms group (SOM+group, PHQ-15 score ≥ 10) and control group (SOM-group, PHQ-15 score < 10), with 75 patients in each group. The patients completed the illness attribution questionnaire while waiting to see the doctor. After visiting the doctor, each patient and doctor were invited to finish the patient-doctor relationship questionnaire (PDRQ) or difficult doctor-patient relationship questionnaire (DDPRQ) respectively, as well as to report the degree of satisfaction with the clinic visit and the estimated time of this doctor-visiting.

  Results  The SOM+ group were more likely than the SOM-group to attribute their illnesses to psychological factors (16.0±4.3 vs. 13.5±4.9, P < 0.01) and culture-specific factors (6.5±1.8 vs. 5.6±1.8, P < 0.01). Moreover, the total score of PDRQ in the SOM+ group was significantly lower than that in the SOM- group (37.7±6.7 vs. 39.6±6.4, P=0.011), so did the scores for items "my doctor can help me", "my doctor has enough time for me", and "I am satisfied with the treatment" (P=0.028, 0.038, 0.022). On the other hand, the doctor-reported scores were also higher in the SOM+ group regarding "frustrated by the patient's vague complaints" and "caring for this patient is time-consuming" (P=0.047, 0.021), while lower for the item "I felt at ease when with this patient" (P=0.014). The degrees of satisfaction of both patients and doctors in the SOM+ group were significantly lower than those in the SOM- group (P=0.048, 0.044). The patients reported no significant difference in visit time between the SOM+ group and the SOM- group (P=0.814), but the doctors-reported visit time in the SOM+ group was longer than that in the SOM- group (P=0.030).

  Conclusions  Patients with multiple somatic symptoms attribute their illness to both psycho-social factors and physical factors. Relationship between doctors and these patients is difficult. Patients are likely to feel not being helped or given enough time, while doctors are likely to feel frustrated and time-consuming.