Linguistic and interactional aspects that characterize consultations about medically unexplained symptoms: A systematic review

Aim: Communication between patients and providers has been shown to be crucial for mutual understanding and improvement of medically unexplained symptoms (MUS). The aim of this systematic review is to gain a detailed understanding of recurrent communication practices and their functions in medical interactions about MUS, by synthesizing evidence from interactional and discourse analyses. Methods: Systematic review of qualitative linguistic and interactional studies. We searched 8 electronic databases, screened reference lists and consulted experts. We developed a data extraction template and appraised the quality of the studies. Findings were synthesized through an iterative process. Results: We found 5021 publications of which 17 met the inclusion criteria. We sorted findings into three different interactional areas: 1) patients and providers orient to the importance of recognition of symptoms and suffering, e.g. by using extreme case formulations ("terrible") to portray the severity of complaints; 2) patients and providers orient to their separate conflicting epistemic territories (i.e. conflicts in knowledge domains), e.g. with physicians using restricted question-answer sequences; and 3) the diagnosis is constructed in interaction, e.g. by searching for common ground with frames that are acceptable for patients. Conclusion: Linguistic and interactional aspects in medical consultations show that talking about MUS is a very delicate activity. Treating MUS as delicate could elicit patient resistance. Providers can overcome resistance by constructing explanations in a collaborative manner and by searching for common ground.