Assessment and Treatment of Functional Disorders in General Practice: The Extended Reattribution and Management Model—An Advanced Educational Program for Nonpsychiatric Doctors

Fink, Per; Rosendal, Marianne; Toft, Tomas

doi:10.1176/appi.psy.43.2.93

Cited by 128 publications

(81 citation statements)

References 45 publications

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“…doctors' and patients' illness and disease concepts, management strategies, and how to maintain a wellfunctioning doctor-patient relationship. However, despite the development of certain educational tools [11,12], GPs still face severe challenges in the management of patients with MUS. Qualitative studies of the management of MUS have mainly provided self-contained and descriptive results, confined to the context of the immediate sampling.…”

Section: Introductionmentioning

confidence: 99%

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Johansen

Risør

2017

Patient Education and Counseling

101

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Please cite this article as: Johansen May-Lill, Risor Mette Bech.What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies.Patient Education and Counseling http://dx.doi.org/10.1016/j.pec. 2016.11.015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Highlights:-For GPs, dominant disease models (biomedical or psychosocial) often do not fit with reality -Both patients and doctors struggle with and suffer from this incongruence -In the lack of congruent disease models, a validating doctorpatient relationship can be a lifeline 2 Abstract:Objective To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. MethodsWe used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. ResultsThe problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless. In the face of cognitive incongruence, GPs have strived to achieve relational congruence with their patients. This has led to parallel positive experiences of mutual trust and validation. With more experience, some GPs seem to overcome the incongruences, and later studies point towards a reframing of the MUS problem. ConclusionFor GPs, the challenge with MUS is most importantly at an epistemological level. Hence, a full reframing of the problem of MUS for GPs (and for patients) implies broad changes in basic medical knowledge and education. 3Practice Implications Short-term: Improve management of patients with MUS by transferring experience-based, reality-adjusted knowledge from senior GPs to juniors. Long-term: Work towards new models of disease that integrate knowledge from all relevant disciplines.199 words

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Section: Introductionmentioning

confidence: 99%

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Johansen

Risør

2017

Patient Education and Counseling

101

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“…We can see several trials for the better treatment for MUS7 in Denmark, including the educational program for general practitioners (GPs)8 or some group psychotherapies 9, 10, 11. The educational program is called as the extended reattribution and management model for functional disorders (TERM),12 and is applied nationwide in Denmark. It explains GPs how to understand, how to communicate, how to treat or manage these patients 13.…”

Section: Tablementioning

confidence: 99%

“…And the therapeutic structure or the communication between the doctor and the patient is also important21, 22, 23 in the treatment of MUS patients. TERM12 focuses just on the relationship and consists of five components13 (Table 2). Step A is the patient's part which focuses on making the patient feel heard and understood.…”

Section: Tablementioning

confidence: 99%

An introduction for the treatment and educational strategy of medically unexplained symptoms in Denmark

Ohta

2017

J of Gen and Family Med

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“…In general, medical definitions and terms address symptoms as something that both presumably invokes inner sensations and induces actions on behalf of these sensations. One definition of such conditions has been phrased as: 'Conditions where the patient complains of physical symptoms that cause excessive worry or discomfort or lead the patient to seek treatment but for which no adequate organ pathology or patho-physiological basis can be found' (Fink et al 2002). A more recent definition that leaves out care-seeking and focuses even more on the symptoms as the dominating phenomena is ''medically unexplained or functional somatic symptoms are complaints defying the clinical picture of known, verifiable, conventionally defined diseases and unbacked by clinical or paraclinical findings.…”

Section: Primary Unexplained Conditionsmentioning

confidence: 99%

What is called symptom?

Eriksen

Risør

2013

Med Health Care and Philos

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Assessment and Treatment of Functional Disorders in General Practice: The Extended Reattribution and Management Model—An Advanced Educational Program for Nonpsychiatric Doctors

Cited by 128 publications

References 45 publications

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

An introduction for the treatment and educational strategy of medically unexplained symptoms in Denmark

What is called symptom?

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