Doctors' attachment style and their inclination to propose somatic interventions for medically unexplained symptoms

Peter Salmon, Larry Wissow, Janine Carroll, Adele Ring, Gerry M. Humphris, John C. Davies, Christopher F. Dowrick

Research output: Contribution to journalArticle

Abstract

Objective: We tested the theory that general practitioners (GPs) offer somatic intervention to patients with medically unexplained symptoms (MUS) as a defensive response to patients' dependence. We predicted that GPs most likely to respond somatically after patients indicated symptomatic or psychosocial needs had attachment style characterised by negative models of self and others. Method: Twenty-five GPs identified 308 patients presenting MUS and indicated their own models of self and others. Consultations were audio recorded and coded speech-turn-by-speech-turn. We modeled the probability of GPs proposing somatic intervention on any turn as a function of their models of self and other and the number of prior turns containing symptomatic or psychosocial presentations. Results: Prior psychosocial presentations decreased the likelihood of GPs offering somatic intervention. The decrease was greatest in GPs with most positive models of self and, contrary to prediction, least positive models of others. The positive relationship between prior somatic presentations and the likelihood that GPs offered somatic intervention was unrelated to either model. Conclusion: Findings are incompatible with our theory that GPs propose somatic interventions defensively. Instead, GPs may provide somatic intervention because they value patients (positive model of others) but devalue their own psychological skills (negative model of self).

Original languageEnglish (US)
Pages (from-to)104-111
Number of pages8
JournalGeneral Hospital Psychiatry
Volume30
Issue number2
DOIs
StatePublished - Mar 1 2008

Keywords

  • Attachment
  • Communication
  • Medically unexplained symptoms
  • Primary care

ASJC Scopus subject areas

  • Psychiatry and Mental health

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