General practitioners' attributions of fatigue
Introduction
Fatigue is a common phenomenon. In a study by Bensing and Schreurs (1995), a quarter of the sampled Dutch population admitted to having been troubled by fatigue during the previous 2 weeks. In a large-scale British study, 18.3% of the sample reported substantial fatigue lasting 6 months or longer (Pawlikowska et al., 1994). In a study representative for U.S. adults, 14.3% of the sampled men and 20.4% of the sampled women reported suffering from fatigue (Chen, 1986). When these people decide to go to a general practitioner (GP) because they feel tired, their fatigue turns into a medical problem. In a Canadian study among primary-care patients, 13.6% of the sample appeared with fatigue as the complaint (Cathébras et al., 1992); in a French study, 7.6% of a representative sample of primary-care patients did so (Fuhrer and Wessely, 1995). From a primary-care perspective, fatigue has a relatively high prevalence: it is the third most common reason for encounter in Dutch family medicine (Lamberts et al., 1993). In the present study, what happens during such a medical consultation in the Netherlands is further examined with special attention to the GP's attribution process.
Section snippets
Attribution of fatigue in general practice
General practitioners (GPs) are often puzzled by complaints of fatigue. As Zola (in Radley, 1994) has observed, they generally regard complaints about being tired as vague because they do not clearly relate to an underlying disease. Studies have revealed a variety of causes for fatigue: psychological (e.g. depression) or physical diseases (e.g. virus infections or anaemia); aspects of the patient's life (e.g. overwork, insufficient sleep or too little activity); external factors such as drugs
Research questions
In order to study the attribution processes during medical consultations for fatigue, the following two research questions were formulated;
(1) How do the sociodemographic characteristics of patients, their other complaints and any underlying diseases/problems relate to the GPs' somatic–psychosocial attributions?
(2) What relations appear to exist between the GPs' somatic–psychosocial attributions and the characteristics of the medical consultation?
Procedure
The data used in this study come from The Dutch National Study of Morbidity and Intervention in General Practice conducted during 1986–1987 by the NIVEL (Netherlands Institute of Primary Health Care). The data encompass three levels (Foets and van der Velden, 1990): (1) the general-practitioner level with a survey among all 161 affiliated GPs; (2) the medical-consultation level with continuous registration of all health problems presented and related data in all affiliated Dutch general
Analysis
In order to study the first research question, tests were conducted to determine which patient-related characteristics led to significant differences in the somatic–psychosocial attributions made by the GPs. In order to determine the strength of the relations for the nominal patient variables, separate ANOVAs were performed with each patient-related characteristic as the independent variable and the GPs' somatic–psychosocial attributions as the dependent variable. When a significant effect was
GPs' somatic–psychosocial attributions
In Fig. 1, distribution of the GPs' somatic–psychosocial attributions is depicted. The mean was 2.70 (SD 1.44, range 1–5).
Descriptive statistics
In Table 1, the descriptive statistics for the patient characteristics are presented. For the ordinal variables re-coded using PRINCALS, both the means and percentages are given. The descriptive statistics for the consultation characteristics are presented in Table 2.
Relations between patient characteristics and GPs' somatic–psychosocial attributions
In Table 3, the results of one-way analyses of variance to determine the relations between the nominal
Discussion
The purpose of this study was to investigate the relations between patient-related characteristics, GPs' somatic–psychosocial attributions and the consultation characteristics of the medical consultations prompted by a complaint of fatigue. About a quarter of the variability in the GPs' somatic–psychosocial attributions could be explained on the basis of the variables considered here. The GPs' attributions were also found to be related to specific characteristics of the consultation. With
Acknowledgements
The authors are grateful to Professor David Ingleby from the department of Clinical Psychology and Health Psychology for his kind help with the PRINCALS analysis.
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