Helping GPs identify patients with persistent somatic symptoms earlier

Medical psychologist Willeke Kitselaar has developed a model that helps identify patients with persistent somatic symptoms earlier, based on an extensive large medical database. "I advise GPs to ask patients to fill in a questionnaire about both physical and mental symptoms at an earlier stage." Kitselaar's Ph.D. defense takes place on 27 June.

For about 50% of patients who consult their GP, their complaints are unexplained. Usually the symptoms go away by themselves, but in about 10% of cases, their symptoms of chronic fatigue, for example, are permanent. Kitselaar wanted to help this group of patients because they often do not receive adequate treatment. "The earlier these patients are identified, the less likely it is that the symptoms will worsen. Otherwise, a difficult doctor-patient relationship can also develop in which you can't look for solutions together."

Electronic patient dossier

Mattijs Numans, Professor of General Practitioner Medicine at LUMC Health at Campus The Hague, is one of the two supervisors. It was Numans who put Kitselaar on this track. "We have a lot of data from the electronic patient dossiers, data that you can use to develop a model that will predict persistent somatic symptoms (PSS)," he explains. "Such a model can help GPs identify these patients at an earlier stage."

Kitselaar needed a recognizable code for her prediction model to identify which patients run the risk of PSS based on the electronic patient dossiers. She therefore first conducted a survey among GPs asking which codes they use for these kinds of symptoms. "In practice, GPs all seem to use a different system to record this information. Half the GPs acknowledge that the lack of a uniform method of record-keeping is a problem."

From a two-track to a multi-track approach

Persistent somatic complaints often turn out to involve biological as well as psychological, behavioral and social aspects. Although this has been known for some time, it has proved difficult to integrate these factors into medicine. This is partly due to the mainly biomedical approach to medicine and the two-track policy that recognizes either physical or mental symptoms.

Kitselaar would advise GPs in any event to administer a short questionnaire—the Four-Dimensional Symptom Questionnaire 4DSQ—at an earlier stage. "This kind of questionnaire gives a broader picture and so directly helps the GP to identify treatable indictors outside the biomedical domain."

"At the moment, GPs only start to take a broader view if a patient comes to see them more frequently with symptoms and after a lot of possibilities have already been ruled out. Our prediction model identifies PSS patients earlier. This can be useful to alert GPs to switch from a two-track approach to a multi-track approach where the social context is also taken into consideration, along with all other aspects that can have an influence on the patient's health. The study is still under development and a better model is needed for recording the problems, including outside the biomedical domain."

Support and training for GPs

GPs indicate that even in the case of early recognition they are unsure what action to take because they are concerned that there may still be some underlying medical issue. In her survey, Kitselaar also asked what was important for GPs. "They need more support and more training. There's a lot that can be gained from that. The Practice Support GPs in Mental Healthcare can be involved and they often already administer the 4DSQ."

Kitselaar is now a postdoc at the Vrije Universiteit Amsterdam in the Biological Psychology department. However, she is still indirectly involved in a new study into persistent somatic symptoms being conducted at LUMC Campus The Hague in collaboration with the PSS practitioner experts from the Emovere Foundation. Care professionals are educated there in the body-mind approach where attention is paid to the interaction between body and mind and how to treat persistent symptoms. Kitselaar is happy about that. "That seems to be a good step in the right direction," she said.