‘They’ve just got symptoms without science’: Medical trainees’ acquisition of negative attitudes towards patients with medically unexplained symptoms

Shattock, Lucy; Williamson, H O; Caldwell, Kim A.; Anderson, Kate; Peters, Sarah

doi:10.1016/j.pec.2012.12.015

Cited by 45 publications

(47 citation statements)

References 37 publications

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“…10 A recent study exploring medical student attiudes also found a lack of formal training in medically unexplained symptoms, and senior role models to be influential in shaping students' attitudes and approach. 12 Patients' presenting symptoms varied according to specialty, although with some overlap in areas such as pain and fatigue, consistent with other studies. 13,14 Several doctors interviewed highlighted the importance of attempting to understand the patient's expectations, as in a recent review of the literature on effective communication with patients presenting with medically unexplained symptoms.…”

Section: Comparison With Existing Literaturesupporting

confidence: 88%

How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

et al. 2017

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SummaryObjective: Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design: A qualitative study using in-depth interviews and thematic analysis. Setting: Three hospitals in the North Thames area. Participants: Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure: Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results: There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor's level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions: Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

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Section: Comparison With Existing Literaturesupporting

confidence: 88%

How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

et al. 2017

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“…The current study suggests that training and education for HPs may lack information about GID and the impact on daily life, relationships, and psychological health supporting research in medically unexplained symptoms . Therefore, more research needs to be conducted into this condition so that patients can be diagnosed and receive care sooner without encountering the struggle of “diagnosis by exclusion.” More research and wider dissemination of findings may also help raise awareness of GID in the general public. The benefits of this are 2‐fold, first helping to reduce stigma for those diagnosed with GID when out socially and second to help those who have not received a diagnosis recognize symptoms and receive appropriate treatment.…”

Section: Discussionmentioning

confidence: 96%

Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis

Twist

Ablett

Wearden

et al. 2018

Neurogastroenterology Motil

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“…Once the patient feels understood the GP can then go on to discuss the management of the condition [44]. CFS/ME therefore needs to be presented to students in a positive way, with clear and simple messages [45,46]. This could mean teaching students about these conditions first before they start to habitually use the biomedical model as a prototype for all conditions.…”

Section: Discussionmentioning

confidence: 99%

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

et al. 2014

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BackgroundThe NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.MethodsA meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.ResultsTwenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.ConclusionsIn order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.

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‘They’ve just got symptoms without science’: Medical trainees’ acquisition of negative attitudes towards patients with medically unexplained symptoms

Abstract: Current medical training fails to equip doctors to engage with MUS and potentially fosters the development of unhelpful views of these patients. Informed teaching on diagnosis and management of MUS is necessary at a trainee level to limit the development of negative attitudes.

Cited by 45 publications

References 37 publications

How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians

Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

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