Barriers to improving treatment

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

“…in terms of SFD patients' interaction with medical professionals and care-eliciting behaviour) has been proposed as an important dimension to be looked at (Noyes et al, 2008). Further reasons for dissatisfaction with medical care may be rooted in a health-care system poorly equipped to deal with SFD patients (Henningsen et al, 2011). These authors demand an integrated approach that would overcome the dualistic nature of the healthcare system and bridge the gap between psychiatric and medical services.…”

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

“…More descriptive language might be more appropriate and more acceptable to patients. A change in language use and a more nuanced picture of doctors' experiences with and attitudes towards MUS as is provided here, may also reduce the lack of confidence some doctors feel because of a word that subtly devalues their ability to deal with MUS patients [61] [68]. Allowing more room for sharing positive experiences with patients presenting with MUS is also important.…”

“…It also bears negative connotations in so far as "patients are not simply 'difficult to treat' in the sense that they are challenging and stimulating for doctors who want to prove their expertise; rather they are 'difficult difficult' patients, who evoke the negative emotional reactions of frustration and helplessness in their doctors ('heart-sink patients') and seem to undermine rather than stimulate the expertise of the doctor." [61] (p. 126) We therefore consider the usage of 'difficult' in the context of MUS problematic and a potential barrier to improving treatment. In order to counteract its potentially negative impact, a closer understanding of its usage and meanings is needed.…”

“…The shorthand statement 'difficult patient' thus seems to draw together 'difficulties' experienced by doctors vis-à-vis MUS patients in a variety of areas. According to Henningsen et al 's overview on barriers to improving treatment [61], these areas can broadly be described as context, comprising understanding of the condition and service organisation, and doctor-patient encounter, comprising doctor-related factors, patient-related factors and interaction-related factors. In a systematic review of barriers to diagnosis of "non-specific, functional, and somatoform disorders" in primary care, [66] through a grounded-theory approach Murray et al identified that barriers reported in the literature could be interpreted to fall under five very similar thematic categories, namely: patient-related barriers, primary-care physician (PCP) related barriers, interactional barriers, situational barriers, and conceptual and operational barriers.…”

“…Greater awareness of their own emotional reaction might in turn lead to greater awareness for patients' emotional distress which doctors, as Henningsen et al describe it, tend to 'somatise' -i.e. they pick up emotional cues but respond to them by returning to the bodily complaints [61]. Furthermore, it might be helpful to talk more openly about 'difficulties' amongst colleagues rather than, as one participant pointed out informally after the interview (P2, consultant respiratory physician), avoid mentioning 'difficulties' for fear of being considered incompetent.…”