Symptômes médicalement inexpliqués : les représentations des patients et leurs attentes vis-à-vis du médecin généraliste
Year: 2025
Type: dissertation
Abstract: Introduction: medically unexplained symptoms (MUS), without an identified organic cause, are frequent in primary care. They often create a “zone of diagnostic and therapeutic uncertainty,” fueling care-seeking journeys, relational blur, and a weakened alliance marked by shared feelings of misunderstanding. This and the limited space given to patients’ voices in the literature highlight the need to directly explore patients’ lived experiences and their expectations of general practitioners. Method: Qualitative study based on semi-structured interviews with adults presenting MUS. Participants were recruited via general practitioners using purposive sampling with maximum variation. An inductive reflexive thematic analysis was conducted. Interviews continued until thematic saturation; they were conducted in person or by video conference, audio-recorded, fully transcribed, anonymized, and cross-analyzed to generate findings. Results: patients describe representations that interweave predisposing, precipitating, and perpetuating factors. They report multi-level impacts on daily life and the coping strategies they deploy, between acceptance and hope of recovery. Expectations center on the relationship: being believed, listened to, and considered; receiving transparent explanations when possible; avoiding overmedicalization; benefiting from coordinated follow-up and adapted timelines; in short, personalized care. The “doctor-as-medicine” figure, mind–body linkage, consultation and follow-up modalities, adaptability, and transparency emerge as therapeutic levers. Conclusion: recentering the consultation on the person - listening, validation, clear framing, coordination, and a relationship that evolves - while avoiding unjustified tests and prescriptions enables GPs to embody a distinct therapeutic role through a bio-medico-psycho-social approach. Grounded in patients’ accounts, this thesis offers practical guidance to support care and follow-up for MUS and to strengthen the therapeutic alliance (co-scheduled consultations, key phrases, management of uncertainty and relational space, reasoned referral, etc.).
Source: HAL
Author: Delaittre, Anne-Laure
Institution: Université Paris Cité
Language: French
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7153957632