The social negotiation of illness: Doctors’ role as clinical or political in diagnosing patients with medically unexplained symptoms

Mik‐Meyer, Nanna

doi:10.1057/sth.2014.15

Cited by 8 publications

(16 citation statements)

References 34 publications

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“…First, regarding the negative effects of biomedical framing of MUS, studies typically report that GPs experience negative emotions when working with MUS, such as uncertainty, fear, frustration and powerlessness [ 2 , 3 , 37 – 41 ]. Yet few studies attempt to understand the cause of the negative emotions on a deeper level.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the GPs ‘felt they had the opportunity to ‘know’ such patients better (than other doctors), and build a relationship upon which successful management could be based’ [ 39 ]. GPs are also typically reported to explain MUS by considering the sick person in his or her psychosocial context [ 2 , 3 , 37 , 39 , 40 , 48 – 50 ]. While the link between this understanding and a form of biopsychosocial framing is rarely explicated, it is certainly indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Medically unexplained symptoms (MUS) is an umbrella term used to refer to various symptoms that ‘have no identified organic basis’ [ 1 ], and ‘for which no adequate medical explanation can be found after a proper medical examination’ [ 2 ]. As such, MUS force general practitioners (GPs) to base clinical judgements on something other than biomedical evidence [ 3 ]. Cases involving MUS are said to ‘test the credibility of the doctor (…) for his or her inability to label the patient’s complaint’ [ 4 ], and it is well documented that MUS can be a challenge to both patient and doctor [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

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How general practitioners understand and handle medically unexplained symptoms: a focus group study

Rasmussen

Rø

2018

BMC Fam Pract

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BackgroundMedically unexplained symptoms (MUS) are a common yet challenging encounter in primary care. The aim of this study was to explore how general practitioners (GPs) understand and handle MUS.MethodsThree focus group interviews were conducted with a total of 23 GPs. Participants with varied clinical experience were purposively recruited. The data were analysed thematically, using the concept of framing as an analytical lens.ResultsThe GPs alternated between a biomedical frame, centred on disease, and a biopsychosocial frame, centred on the sick person. Each frame shaped the GPs’ understanding and handling of MUS. The biomedical frame emphasised the lack of objective evidence, problematized subjective patient testimony, and manifested feelings of uncertainty, doubt and powerlessness. This in turn complicated patient handling. In contrast, the biopsychosocial frame emphasised clinical experience, turned patient testimony into a valuable source of information, and manifested feelings of confidence and competence. This in turn made them feel empowered. The GPs with the least experience relied more on the biomedical frame, whereas their more seasoned seniors relied mostly on the biopsychosocial frame.ConclusionThe biopsychosocial frame helps GPs to understand and handle MUS better than the biomedical frame does. Medical students should spend more time learning biopsychosocial medicine, and to integrate the clinical knowledge of their peers with their own.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0745-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How general practitioners understand and handle medically unexplained symptoms: a focus group study

Rasmussen

Rø

2018

BMC Fam Pract

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“…Specifically, doctors' lack of attention to patients' experiences and understandings were seen as undermining these professional's capacities to engage in due diligence. In turn, questions of expertise often were thought of in terms of questions of motive, and doctors and patients were seen as having different stakes (see Greco, 2012;Mik-Meyer, 2015).…”

Section: Discussionmentioning

confidence: 99%

Doctor Distrust: Pragmatism, Intersectionality, and the Confluence of Expertise and Interests

Williams¹

2017

IJSSS

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The idea that only experts can be privy to knowledge about the world has been strongly contested throughout recent history. Using interviews with 39 British seniors tasked to discuss the role of doctors in matters of life and death, I argue that distrust for expert knowledge stems largely from the belief that knowledge is deeply shaped by personal experience. However, such distrust is not absolute as respondents still hold some faith in medical expertise due to their own perceived lack of medical knowledge and experiences with the medical field. As such, I assert that respondents demonstrate ambivalence towards medical expertise due to the confluence of expertise and interests that they find in the role that doctors play in assisting individuals with their health. I connect my findings to the theoretical traditions of American pragmatism and intersectionality to demonstrate how the ambivalence demonstrated by respondents signals their tacit use of a combination of these theories or what I term pragmatic intersectionality.

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“…Although on the face of it, this is a harmonious process that leads to a negotiated agreement, disagreements can arise at just about every phase. 3 Patients and their physicians almost always disagree on some aspect of treatment, diagnosis, or even the nature of symptoms. A healthy relationship between the doctor and patient can help navigate disagreements.…”

Section: Introductionmentioning

confidence: 99%

Electronic Support Groups: An Open Line of Communication in Contested Illness

2016

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Background Patients with functional somatic syndromes are often difficult to treat. The relationship between doctors and patients can be strained, which limits communication. Instead, patients often communicate with each other over the Internet in electronic support groups. Objective This perspective summarizes studies of patient-to-patient communication over the Internet and uses the concept of contested illness to provide insights into the experiences of patients with functional somatic disorders. Discussion Conflict between a patient and their physician is a key feature of functional somatic syndromes. Physicians and patients do not have a shared understanding or appreciation of the patient’s experiences. Patients with functional somatic syndromes often value their own embodied experience over medical knowledge. At the same time, they remain deeply invested in finding a “good doctor” who believes that the patient is suffering, agrees with their conception of the cause, and assents to the treatment as directed by the patient. Electronic support groups reinforce these beliefs. Conclusion Patients may benefit from a compromising, collaborative approach that is realistic about the limitations of medical knowledge. However, physicians should not engage in unsafe treatment practices. Electronic support groups exist for a wide range of illnesses and the issues that rise to the surface in functional somatic syndromes likely occur to some extent with almost every patient.

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The social negotiation of illness: Doctors’ role as clinical or political in diagnosing patients with medically unexplained symptoms

Cited by 8 publications

References 34 publications

How general practitioners understand and handle medically unexplained symptoms: a focus group study

How general practitioners understand and handle medically unexplained symptoms: a focus group study

Doctor Distrust: Pragmatism, Intersectionality, and the Confluence of Expertise and Interests

Electronic Support Groups: An Open Line of Communication in Contested Illness

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