What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

Maatz, Anke; Wainwright, Megan; Russell, Andrew J.; Macnaughton, Jane; Yiannakou, Yan

doi:10.1016/j.jpsychores.2016.09.005

Cited by 22 publications

(29 citation statements)

References 51 publications

(48 reference statements)

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“…Doctors in many countries are discussing how to deal with patients who have somatization symptoms [24]. In particular, doctors who do not specialize in psychological treatment have a tendency to think that patients suffering from a somatization symptom are “difficult” to deal with [25] and seem to think that it takes more energy to take care of such patients than regular patients. In fact, in this study eight patients who had a diagnosis of an organic disease complained about malaise and, accordingly, it took more effort to determine these patients’ major complaints than those of usual patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

Nakamura

Takeuchi

Hashimoto

et al. 2017

BioPsychoSocial Med

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BackgroundSomatization is produced due to the summation of psychological factors, irrespective of the presence or absence of physical factors. A group of diseases with severe pain and other disorders exhibit so-called Medically Unexplained Symptoms (MUS), and the characteristics of patients with MUS are largely unexplained. In this paper, the characteristics of a series of new patients with somatization treated in a Japanese university hospital are discussed.MethodThe subjects were 871 patients who newly visited the Department of Psychosomatic Medicine, Toho University Omori Medical Center between January and December of 2015. Under the assumption that the definition of somatization is same as that of MUS, the correlation between somatization and the age, sex, academic background, chief complaints, reasons for visiting the medical center, diagnosis, symptoms, presence or absence of a referral form, continued treatment after the first visit, and marital status of these patients at the time of their respective examinations were evaluated.ResultsOf the patients studied, 68% suffered from somatization. Among them, 11% met the definition of Functional Somatic Symptoms (FSS) and 74% had somatization associated with mood disorder or anxiety disorder. Digestive symptoms were reported by 33%, headaches by 24%, and unusual sensations by 21%. Whereas no correlation was found between somatization symptoms and the patients’ academic background, marital history, or medical history after the first visit, a positive correlation (p < 0.05) was found between somatization and patients who had been referred by their doctor.ConclusionMany of the studied patients who suffered from somatization, regardless of age and sex, were referred to us by doctors from other hospitals. It was concluded that many patients difficult to diagnose or deal with are referred the Department of Psychosomatic Medicine of Japanese university hospitals, thus these hospitals must assume great responsibility for preventing mistaken diagnoses by conducting effective psychological treatment and thorough medical examinations.

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Section: Discussionmentioning

confidence: 99%

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

Nakamura

Takeuchi

Hashimoto

et al. 2017

BioPsychoSocial Med

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“…Yon et al found that junior doctors feel incompetent in working with patients with medically unexplained symptoms and frustrated and anxious by this [ 32 ]. Without a more helpful model, they categorise patients as malingers or mentally ill. Maatz et al discussed the concept of ‘difficult’ to treat MUS patients and the negative reactions that can occur when secondary care physicians face these patients and feel frustrated and unable to help them [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

‘If it’s a medical issue I would have covered it by now’: learning about fibromyalgia through the hidden curriculum: a qualitative study

et al. 2017

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BackgroundFibromyalgia syndrome (FMS) is a long-term condition that affects between 1 and 5% of the general population and lies within the spectrum of medically unexplained symptoms (MUS). FMS can be difficult to diagnose and is usually done so as a diagnosis of exclusion. There is continuing debate regarding its legitimacy excluding other causes of symptoms. It is known that the diagnosis and management of MUS, including FMS, receives little attention in medical curricula and attitudes towards patients with FMS amongst medical professionals and trainees can be negative. The purpose of this study was to investigate how attitudes and perspectives of undergraduate medical students towards FMS are acquired during their training.MethodsQualitative interviews with 21 medical students were conducted to explore their views on FMS, encounters with patients with FMS, and where learning about FMS occurs. Participants were recruited from two English medical schools and the study was approved by two University Ethics committees. Interviews were digitally recorded with consent and data analysed thematically, using principles of constant comparison.ResultsThe data were organised within three themes: i) FMS is a complex, poorly understood condition; ii) multiple sources for learning about FMS; and iii) consequences of negative attitudes for patients with FMS.ConclusionUndergraduate medical students have limited understanding of, and are sceptical over the existence of FMS. These attitudes are influenced by the ‘hidden curriculum’ and witnessing attitudes and actions of their clinical teachers. Students interpret a lack of formal curriculum teaching around FMS to mean that it is not serious and hence a low priority. Encountering a patient, friend or family member with FMS can increase knowledge and lead to altered perceptions of the condition.Teaching and learning about FMS needs to be consistent to improve knowledge and attitudes of clinicians. Undergraduate students should be exposed to patients with FMS so that they better understand patients with FMS.

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“…Sign Similar to other complex or atypical presentations, many patients are not diagnosed accurately in the early stages and even if they are, feelings of frustration and uncertainty often develop in both patient and doctor. 4 Doctors may feel powerless and inadequate and often refer such patients for further investigations or opinions. 5 As illustrated in this example, patients can become stuck in a fruitless succession of medical appointments without resolution of problems.…”

Section: Categorymentioning

confidence: 99%

Emerging models for successful treatment of complex regional pain syndrome in children and young adults

Dunbar¹,

Wilson

2019

J Prim Health Care

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Complex regional pain syndrome (CRPS) is a relatively common condition that is often not well recognised or treated adequately. Patients are usually referred to multidisciplinary pain services, but outcomes remain variable. This case report describes a recent patient with CRPS who was treated quickly and effectively through a simple explanation of the relationship between mind and body, and who then was able to modify her own thought processes and behaviours. This single intervention enabled a complete resolution of symptoms. This report illustrates the clinical application of recent insights into neuroplasticity and individually tailored patient self-management that may now offer successful treatment of an otherwise chronic and disabling condition, especially in younger patients. There are implications for doctors in current practice, as well as for the training of medical students and junior doctors.

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What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

Cited by 22 publications

References 51 publications

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

‘If it’s a medical issue I would have covered it by now’: learning about fibromyalgia through the hidden curriculum: a qualitative study

Emerging models for successful treatment of complex regional pain syndrome in children and young adults

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