Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, yet this care may be influenced negatively by nonconcordance between veterans’ and providers’ views of MUS. We surveyed 243 veterans with MUS and evaluated the degree of nonconcordance perceived by veterans and their primary care providers regarding their MUS, as well as the effect of perceived nonconcordance on treatment behaviors and outcomes. Approximately 20% of veterans in our sample perceived nonconcordance with their provider regarding their MUS. In turn, perceived nonconcordance predicted important outcomes of interest, particularly veterans’ satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. We discuss future research directions for counseling psychologists.
AzoulayL.Ehrmann-FeldmanD.TruchonM.RossignolM. (2005). Effects of patient–clinician disagreement in occupational low back pain: A pilot study. Disability and Rehabilitation, 27, 817–823. doi:10.1080/09638280400018684
2.
BordinE. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252–260. doi:10.1037/h0085885
3.
Chew-GrahamC.DowrickC.WeardenA.RichardsonV.PetersS. (2010). Making the diagnosis of chronic fatigue syndrome/myalgic encephalitis in primary care: A qualitative study. BMC Family Practice, 11, 1–7. doi:10.1186/1471-2296-11-16
4.
ClaibornC. D.WardS. R.StrongS. R. (1981). Effects of congruence between counselor interpretations and client beliefs. Journal of Counseling Psychology, 28, 101–109. doi:10.1037/0022-0167.28.2.101
5.
DroletA. L.MorrisonD. G. (2001). Do we really need multiple-item measures in service research?Journal of Service Research, 3, 196–204. doi:10.1177/109467050133001
EdwardsJ. R. (2002). Alternatives to difference scores: Polynomial regression analysis and response surface methodology. In DrasgowF.SchmittN. W. (Eds.), Advances in measurement and data analysis (pp. 350–400). San Francisco, CA: Jossey-Bass.
8.
FuertesJ. N.MislowackA.BennettJ.PaulL.GilbertT. C.FontanG.BoylanL. S. (2007). The patient–provider working alliance. Patient Education and Counseling, 66, 29–36. doi:10.1016/j.pec.2006.09.013
9.
GreerJ.HalginR. (2006). Predictors of physician-patient agreement on symptom etiology in primary care. Psychosomatic Medicine, 68, 277–282. doi:10.1097/01.psy.0000203239.74461.db
10.
HahnS. R. (2001). Physical symptoms and physician-experienced difficulty in the physician–patient relationship. Annals of Internal Medicine, 134, 897–904. doi:10.7326/0003-4819-134-9_Part_2-200105011-00014
11.
HeijmansM.FoetsM.RijkenM.SchreursK.de RidderD.BensingJ. (2001). Stress in chronic disease: Do the perceptions of patients and their general practitioners match?British Journal of Health Psychology, 6, 229–242. doi:10.1348/135910701169179
12.
KaneR. L.MaciejewskiM.FinchM. (1997). The relationship of patient satisfaction with care and clinical outcomes. Medical Care, 35, 714–730. doi:10.1097/00005650-199707000-00005
13.
KangH. (2013). The prevention and handling of the missing data. Korean Journal of Anesthesiology, 64, 402–406. doi:10.4097/kjae.2013.64.5.402
14.
LangeG.McAndrewL. M.AshfordJ. W.ReinhardM.PetersonM.HelmerD. A. (2013). War Related Illness and Injury Study Center (WRIISC): A multidisciplinary translational approach to the care of veterans with chronic multisymptom illness. Military Medicine, 178, 705–707. doi:10.7205/MILMED-D-13-00053
15.
LeventhalH.BrissetteI.LeventhalE.A. (2003). The common-sense model of self-regulation of health and illness. In CameronL. D.LeventhalH. (Eds.), The self-regulation of health and illness behaviour (pp. 42–65). London, UK: Routledge.
16.
MalyR. C.LeakeB.FrankJ. C.DiMatteoM. R.ReubenD. B. (2002). Implementation of consultative geriatric recommendations: The role of patient–primary care physician concordance. Journal of the American Geriatrics Society, 50, 1372–1380. doi: 10.1046/j.1532-5415.2002.50358.x
17.
MondlochM. V.ColeD. C.FrankJ. W. (2001). Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. Canadian Medical Association Journal, 165, 174–179.
18.
Moss-MorrisR. (2011, December). Are illness representations key?The Psychologist, 24(12), 899.
Olde HartmanT. C.BorghuisM. S.LucassenP. L.van de LaarF. A.SpeckensA. E.van WeelC. (2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363–377. doi:10.1016/j.jpsychores.2008.09.018
21.
PerreaultM.PawliukN.VeilleuxR.RousseauM. (2006). Qualitative assessment of mental health service satisfaction: Strengths and limitations of a self-administered procedure. Community Mental Health Journal, 42, 233. doi:10.1007/s10597-005-9028-1
22.
PhillipsL. A. (2013). Congruence research in behavioral medicine: Methodological review and demonstration of an alternative methodology. Journal of Behavioral Medicine, 36, 61–74. doi:10.1007/s10865-012-9401-9
23.
PhillipsL. A.LeventhalE. A.LeventhalH. (2011). Factors associated with the accuracy of physicians’ predictions of patient adherence. Patient Education and Counseling, 85, 461–467. doi:10.1016/j.pec.2011.03.012
24.
PhillipsL. A.LeventhalH.LeventhalE. A. (2012). Physicians’ communication of the Common-Sense Self-Regulation Model results in greater reported adherence than physicians’ use of interpersonal-skills. British Journal of Health Psychology, 17, 244–257. doi:10.1111/j.2044-8287.2011.02035.x
25.
RaineR.CarterS.SenskyT.BlackN. (2004). General practitioners’ perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: Qualitative study. The BMJ, 328, 1354–1357. doi:10.1136/bmj.38078.503819.EE
26.
ReidS.WhooleyD.CrayfordT.HotopfM. (2001). Medically unexplained symptoms—GPs’ attitudes towards their cause and management. Family Practice, 18, 519–523. doi:10.1093/fampra/18.5.519
27.
RingA.DowrickC.HumphrisG.SalmonP. (2004). Do patients with unexplained physical symptoms pressurise general practitioners for somatic treatment? A qualitative study. The BMJ, 328, 1057. doi:10.1136/bmj.38057.622639.EE
28.
RosendalM.OlesenF.FinkP. (2005). Management of medically unexplained symptoms. The BMJ, 330, 4–5. doi:10.1136/bmj.330.7481.4
29.
RoyM. J.KosloweP. A.KroenkeK.MagruderC. (1998). Signs, symptoms, and ill-defined conditions in Persian Gulf War veterans: Findings from the Comprehensive Clinical Evaluation Program. Psychosomatic Medicine, 60, 663–668. doi:10.1097/00006842-199811000-00001
30.
Royal Pharmaceutical Society of Great Britain & MarinkerM. (1997). From compliance to concordance: Achieving shared goals in medicine taking. London, England: Royal Pharmaceutical Society, in Partnership with Merck Sharp & Dohme.
31.
ScottJ.TacchiM. J. (2002). A pilot study of concordance therapy for individuals with bipolar disorders who are non-adherent with lithium prophylaxis. Bipolar Disorders, 4, 386–392. doi:10.1034/j.1399-5618.2002.02242.x
32.
SewitchM. J.AbrahamowiczM.DobkinP. L.TamblynR. (2003). Measuring differences between patients’ and physicians’ health perceptions: The Patient–Physician Discordance Scale. Journal of Behavioral Medicine, 26, 245–264. doi:10.1023/A:1023412604715
33.
ShanockL. R.BaranB. E.GentryW. A.PattisonS. C.HeggestadE. D. (2010). Polynomial regression with response surface analysis: A powerful approach for examining moderation and overcoming limitations of difference scores. Journal of Business and Psychology, 25, 543–554. doi:10.1007/s10869-010-9183-4
34.
ShriveF. M.StuartH.QuanH.GhaliW. A. (2006). Dealing with missing data in a multi-question depression scale: A comparison of imputation methods. BMC Medical Research Methodology, 6, 57. doi:10.1186/1471-2288-6-57.
35.
SmithR. C.LeinC.CollinsC.LylesJ. S.GivenB.DwamenaF. C.. . . GoddeerisJ. (2003). Treating patients with medically unexplained symptoms in primary care. Journal of General Internal Medicine, 18, 478–489. doi:10.1046/j.1525-1497.2003.20815.x
36.
SmithR. C.LylesJ. S.GardinerJ. C.SirbuC.HodgesA.CollinsC.. . . GivenB. (2006). Primary care clinicians treat patients with medically unexplained symptoms: A randomized controlled trial. Journal of General Internal Medicine, 21, 671–677. doi:10.1111/j.1525-1497.2006.00460.x
37.
SpenceM.Moss-MorrisR.ChalderT. (2005). The Behavioural Responses to Illness Questionnaire (BRIQ): A new predictive measure of medically unexplained symptoms following acute infection. Psychological Medicine, 35, 583–93. doi:10.1017/S0033291704003484
38.
StaigerT. O.JarvikJ. G.DeyoR. A.MartinB.BraddockC. H. (2005). BRIEF REPORT: Patient–physician agreement as a predictor of outcomes in patients with back pain. Journal of General Internal Medicine, 20, 935–937. doi:10.1111/j.1525-1497.2005.0175.x
39.
StewartM. A.McWhinneyI. R.BuckC. W. (1979). The doctor/patient relationship and its effect upon outcome. The Journal of the Royal College of General Practitioners, 29, 77–82.
40.
TackettJ.MaciejewskiM. L.RichardsonR. D.HuntS. C.RobertsL. (2005). Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms. Military Medicine, 170, 70–75. doi:10.7205/MILMED.170.1.70
41.
WilemanL.MayC.Chew-GrahamC. A. (2002). Medically unexplained symptoms and the problem of power in the primary care consultation: A qualitative study. Family Practice, 19, 178–182. doi:10.1093/fampra/19.2.178
42.
WittakerR.KempS.HouseA. (2007). Illness perceptions and outcome in mild head injury: A longitudinal study. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 644–646. doi:10.1136/jnnp.2006.101105
