Association of physicians’ illness perception of fibromyalgia with frustration and resistance to accepting patients: a cross-sectional study

Abstract

The aim of this study was to elucidate whether physicians' illness perceptions correlate with their frustration or resistance to accepting patients with fibromyalgia (FM). In this cross-sectional postal survey, questionnaires were sent to member physicians of the Japan College of Rheumatology and Japan Rheumatism Foundation. Measures collected included the Brief Illness Perception Questionnaire with Causal Attribution, the Illness Invalidation Inventory, and the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10). Multiple logistic regression was performed to examine associations between the DDPRQ-10 and resistance to accepting patients with FM for treatment. We analyzed data from 233 physicians who had experience in consulting with patients with FM. Only 44.2 % answered that they wanted to accept additional patients with FM. Physicians' frustration was associated with difficulty controlling symptoms, patients' emotional responses, and causal attribution of FM to patient internal factors. Conversely, lower levels of frustration were associated with causal attributions to biological factors and uncontrollable external factors. However, the "difficult patient" perception did not correlate with resistance to accepting patients with FM. Difficulty controlling symptoms with treatment was the one factor common to both physicians' frustration and resistance to accepting patients with FM. Physicians may hesitate to accept patients with FM not because of the stigmatic image of the "difficult patient," but instead because of the difficulty in controlling the symptoms of FM. Thus, to improve the quality of consultation, physicians must continuously receive new information about the treatments and causes of FM.

Humanistic and economic burden of fibromyalgia in Japan

“…Among these individuals, only 12.5% were actually diagnosed by a physician 34. In addition, among Japanese physicians who had previously treated fibromyalgia patients, less than half (44.2%) self-reported wanting to accept more patients with this chronic pain condition 35. Furthermore, cross-national data showed that Japan had the lowest rate of pain reported (4.4%) and treated (26.3%), compared to other developed countries, including the USA (23.8% experienced pain and 40.1% treated) and Europe (including the UK, France, Germany, Italy, and Spain; 20.2% experienced pain and 47.0% treated) 36.…”

Functional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines

“…Physicians might also be frustrated as a result of difficulties in controlling the symptoms and the patients' emotional responses to the syndromes [6]. Furthermore, it is often assumed that functional limitations in FSS patients are less severe than those in patients with well-defined medical diseases (MD).…”

Comunicación terapéutica en Fibromialgia = Therapeutic communication in Fibromyalgia

“…De esta forma, los pacientes no sólo tienen que soportar el dolor y el resto de síntomas incapacitantes característicos de la enfermedad, sino que también tienen que lidiar con la incredulidad existente por parte de los profesionales que cuestionan su existencia y la asocian con componentes psicológicos (Briones Vozmediano, 2018;Colmenares Roa et al, 2016;Crooks, 2015;Gill Taylor et al, 2016;Reibel & Pearson, 2017). Estas percepciones influyen en la relación y afectan a la calidad de la atención, al retraso del diagnóstico y a la toma de decisiones acerca del tratamiento (Briones Vozmediano et al, 2018;Homma et al, 2016), de manera que los pacientes se sienten insatisfechos, incomprendidos e injustamente tratados con la atención recibida y se encuentran en un estado de ansiedad y frustración continua (Briones Vozmediano et al, 2018;Durif Bruckert et al, 2015;Roth Damas et al, 2018). La llegada del diagnóstico supone una liberación para ellos (Cooper & Gilbert, 2017;Rosselló Aubach, 2017), sin embargo, no siempre se relaciona con mejoras en la atención y en la comunicación (Armentor, 2017;Triviño Martínez et al, 2016), de modo que los pacientes continúan percibiendo injusticia, incomprensión y un trato despectivo por parte de algunos proveedores de salud que creen que exageran los síntomas y que son producto de su imaginación (Cooper & Gilbert, 2017;Ramirez Carmona et al, 2014).…”

“…Los pacientes con una enfermedad crónica de etiología desconocida como la FM necesitan saber más acerca de su enfermedad para comenzar a aplicar estrategias que les permitan controlar su situación (Armentor, 2017). En este sentido, la comunicación por parte de los proveedores de salud es fundamental para conseguir la confianza del paciente y facilitar la toma de decisiones compartida que permita a la persona afectada participar activamente en su enfermedad (Homma, Ishikawa, & Kiuchi, 2016).…”