Physician responses to ambiguous patient symptoms.

Objective: To examine how primary care physicians respond to ambiguous patient symptom presentations.

Design: Observational study, using thematic analysis within a larger cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction.

Setting: Community-based primary care offices within a metropolitan area.

Participants: Twenty-three primary care physicians (internists and family physicians).

Method: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data.

Results: Physicians' responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients' expression of concern, positivity, sensitivity to patients' clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients' perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients' perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning.

Conclusions: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.