Betwixt and between: medical care for functional somatic symptoms

This thesis is about clinical practice: it studies several of the large number of steps taken in the healthcare routes of patients with Functional Somatic Symptoms (FSS). Before a complaint is classified as ‘functional’, the patient is often referred to a somatic specialist. In the referral letter from the general practitioner (GP), specific information was identified that predicts whether a complaint is functional or not. Based on this information, a selection tool was developed. Examination of the letters from the internist to the GP made it clear that the management strategies used for patients with FSS were different from the strategies used for patients with internal disorders. In their daily practice GPs provide explanations for FSS. We found that GPs use seven different components. No pattern could be detected in the many diverse ways in which these components were used. Patients also try to make sense of their complaints by articulating all kinds of connections, for instance between their physical complaints and any negative emotions they experience. Our research revealed that patients link their physical complaints to negative emotions in three different ways. This insight can be important as a starting point for treatment advice. So far, research has paid little attention to self-help actions as management strategy. In this thesis we describe the different types of self-help actions proposed by the GP. We also studied how these self-help actions were created during the conversation between patient and GP, as well as factors that made the patient adopt a specific self-help action.