The frequent consulter in primary medical care

doi:10.1016/0022-3999(86)90032-2

Journal of Psychosomatic Research

Volume 30, Issue 5, 1986, Pages 589-600

https://doi.org/10.1016/0022-3999(86)90032-2 Get rights and content

Abstract

A comparison is reported between a group of frequent consulters of general medical practitioners and a group of infrequent consulters. The frequent consulters reported more symptoms, particularly upper respiratory, gastro-intestinal and back troubles. They took more proprietory medicines and more vitamin pills and were less inclined to ignore symptoms. They were more inclined to negative mood. Although they had slightly fewer stressful life events they coped less well with them, perhaps because they had less satisfactory family and social support and found less distraction in social activities. By means of a model the symptoms of these subjects are contrasted with symptoms found in psychosomatic disorder.

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Social support and cancer progression: A systematic review
2009, Journal of Psychosomatic Research
Citation Excerpt :
Interestingly, those results suggested that the most isolated patients were not more likely to be diagnosed at a later disease stage than the patients with most social connections. There is an alternative possibility that people with fewer social resources for coping with stress might have used the medical system more frequently than their nonlonely counterparts [55]. The potential mediating role of patient delay in the relationship between social support and prognosis needs further testing.
The variability in the conceptualization and categorization of social support has resulted in mixed findings regarding its role in cancer progression. This systematic review identifies and summarizes the evidence for the significance of two important indices of social support in progression of different cancers.
We used systematic and replicable methods to search, select, and evaluate findings.
Thirty-one longitudinal prospective findings (in 26 papers) which were selected for inclusion categorized social support into structural and functional support. The types of cancer included in these studies fell into three major categories: breast cancer (16), other cancer (10), and mixed cancers (5). Results suggest that the evidence for the relationship between social support and cancer progression is sufficiently strong for breast cancer as shown by five out of seven methodologically sound studies but consistently unconvincing for other types of cancer or in studies which combined different types of cancer. Structural support indices were found to be more frequently associated with disease progression than the indices of functional support in breast cancer. Disease-related variables such as severity, treatment, nodal status, and site of metastasis were found to be significant predictors of cancer progression, and it is suggested that these variables must be considered when conducting studies on the role of psychosocial factors in cancer-related outcomes including progression.
Methodological limitations of the studies and counterintuitive findings are discussed, and further conclusive research, particularly randomized controlled trials of social support interventions, is warranted to support the findings of this systematic review.
Frequent attenders in general practice care: A literature review with special reference to methodological considerations
2005, Public Health
Objective. To describe the basis on which our knowledge of frequent attendance in general practice rests and to propose recommendations for further research on frequent attenders (FAs).
Design. The literature review (finished February 2004) encompassed peer-reviewed articles in English describing contacts with general practice in terms of frequency. Searches were performed in the Medline, CINAHL, EMBASE, PsycINFO, Social Sciences Expanded Index and ISI Citation databases with additional searches in reference lists and the ‘related articles’ function in the ISI Citation database and Medline.
Setting. General practice.
Subjects. Sixty-one articles (54 studies).
Measures. The articles were assessed according to the following design variables: setting; definition of FAs; sampling; sample size; control groups; study aim; study design; data sources; effect measure; and main results.
Results. There was no generally accepted definition of frequent attendance. Research designs differed substantially. Eight articles gave sufficient information on all design variables. The top 10% of attenders accounted for 30–50% of all contacts, and up to 40% of FAs were still FAs the following year. More than 50% of FAs had a physical disease, more than 50% of FAs suffered from psychological distress, social factors (low social support, unemployment, divorce) were associated with frequent attendance in more than 50% of FAs, multiproblems (physical, psychological and social) were found in one-third of FAs, and frequent attendance was associated with increasing age and female gender.
Conclusion. The diversity of designs, definitions and methods in the current literature on FAs in general practice hampers comparison of their precision, validity and generalizability, and calls for cautious interpretation and adoption of a common, generally acceptable definition in future studies.
Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study
2004, Social Science and Medicine
Knowledge of which factors are prompting patients to seek primary care is important to the ongoing effort to improve management in general, and management of frequent attenders (FAs) in particular. We conducted a cross-sectional population-based study with the aim at examining associations between physical, mental and social factors and frequent attendance in general practice. We collected questionnaire and registry data in the County of Aarhus (630,000 inhabitants), Denmark. Half of the county general practices (132 practices, 220 GPs) were selected randomly. FAs were defined as the top 10% attenders over the past 12 months. A questionnaire including SF-36 and questions about physical and mental health and social conditions was sent to age and gender stratified samples of FAs and non-FAs from these practices. Impairments (SF-36) associated with frequent attendance were physical in 54–71% (prevalence difference (PD): 16–33%, adjusted prevalence ratio (adj. PR): 1.1–1.7), mental in 58–70% (PD: 17–25%, adj. PR:1.1–1.4) and social in 40–59% (PD: 13–28%, adj. PR:0.9–1.5). Among FAs, 46-88% had used three or more different drugs (PD: 26–39%, adj. PR:1.5–2.3) and 27–41% had been referred one or more times to outpatient specialists (PD: 4–19%, adj. PR:1.2–2.5). Although our data cannot determine the direction of causality, they clearly demonstrate that FAs carry a large burden of physical, mental and social impairments which underpins the complexity and heterogeneity of the problems which they present. The results make clear that biopsychosocial management is a core issue in FA management in general practice.
Emotional profile of physicians who interview frequent attenders
2002, Patient Education and Counseling
Seventy-five physicians at primary health care centers in Spain described their emotions and thoughts during interviews with frequent attenders. Emotion scales were developed by factor and reliability analysis. Positive emotions were associated with younger physician age and with the thought “This patient really needs me.” Feelings of lack of control were associated with rural centers and with the thoughts “Oh my God, him/her again!” and “This patient is really a pain.” Anxiogenic emotions were associated with greater workload, requests for tests, requests to see the doctor outside regular hours, and the thoughts “Oh my God, him/her again!” and “I think this patient is trying to use me.” Guilt feelings were associated with a lower perceived ability to solve the patient’s problem, and with a poor physician–patients relationship. Sadness was associated with more frequent referrals to specialists. Awareness and acceptance of their emotions may improve physicians’ emotional intelligence and physician–patient relationships.
Somatizing frequent attenders in primary health care
2001, Journal of Psychosomatic Research
Objective: The aim of this case-control study was to investigate the association of somatization with frequent attendance in primary health care. Methods: Frequent attenders in a health center (FAs) (N=112) and age- and sex-matched controls (COs) (N=105) constituted the study series. Data were collected from annual statistics, medical records, postal questionnaires and personal interviews. Psychological distress was assessed using Symptom Checklist-36 (SCL-36), alexithymia was measured with Toronto Alexithymia Scale-20 (TAS-20) and hypochondriasis was screened with Whiteley Index (WI). Results: About one-third of FAs were somatizers when a cut-off point of eight symptoms on the SCL-36 somatization subscale was used as a criterion. The significant association of somatization with frequent attendance disappeared in multivariate analyses when adjusted for age, sex and chronic somatic illnesses. Hypochondriacal beliefs and psychiatric comorbidity were connected with FAs' somatization. Hypochondriacal beliefs explained somatizers' frequent attendance. A significant interaction effect between somatization and hypochondriacal beliefs was found when explaining frequent attendance. Conclusions: The results emphasize the need to use a comprehensive approach of somatization, including hypochondriacal beliefs, when treating somatizing FA patients in primary health care.
The no-fault flavor of disability syndromes
2001, Medical Hypotheses
There are many controversial disability syndromes, representing medicolegal and social dilemmas for a variety of medical disciplines. Health care professionals are at a loss to cure these patients, and judges and disability review boards struggle to be fair while at the same time trying to understand the basis and appropriateness of the ever-growing claims of disability. We review these disability syndromes, examining the basis for their existence, their mechanism, and how these patients can better be understood in a constructive and helpful manner. In doing so, we emphasize the sick role, illness behavior, secondary and tertiary gain, and somatization.

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The frequent consulter in primary medical care

Abstract

J Psychosom Res

J Psychosom Res

Medical Sociology

The effects of exposure to cultural change, social change and changes in interpersonal relationships on health

Must we be content with a non-directional 10% of the variance? Reflections on the life events to illness link with some preliminary findings

Life events and psychiatric disorders. Part 1: Some methodological issues

Psychol Med

Social support as a moderator of life stress

Psychosom Med