Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation

Salmon, Peter

doi:10.1016/j.pec.2007.03.008

Cited by 135 publications

(113 citation statements)

References 102 publications

(135 reference statements)

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“…The need for a similar collaborative process has been recognised in relation to GP consultations in a related area: medically unexplained symptoms. 30 The patientled process of developing understanding in the present study, with GPs following but then also subtly shaping patients' understanding, is consistent with this earlier work. Empathic understanding by the GP of the patient's problems is considered important by patients with mental health problems, 6,21 and may be a critical and even necessary precondition of GPs helping patients to develop an understanding of their problems.…”

Section: Comparison With Existing Literaturesupporting

confidence: 90%

Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

et al. 2010

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BackgroundMental health problems are common in primary care and most are managed solely by the GP. Patients strive to understand their mental health problems, and facilitating patients' understanding may be important in their care, yet little is known about this process in GP consultations. AimTo explore how patients' understanding of common mental health problems is developed in GP consultations.

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Section: Comparison With Existing Literaturesupporting

confidence: 90%

Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

et al. 2010

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“…24,38,39 Salmon suggests a way forward and describes how the practitioner needs to fashion an explanation from available medical and lay material that is acceptable to both parties. 36 Patients describe a need to fi nd a way of managing their illness and to infl uence caregivers, including their health professionals. Their narratives describe how they try to gain control over their situation by acquiring knowledge about the illness 40 and presenting this knowledge to their family physician.…”

Section: Comparisons With Published Literaturementioning

confidence: 99%

Using Multiple Sources of Knowledge to Reach Clinical Understanding of Chronic Fatigue Syndrome

Chew‐Graham

Cahill²,

Dowrick³

et al. 2008

The Annals of Family Medicine

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PURPOSE Chronic fatigue syndrome (CFS), or myalgic encephalitis (ME), is a contentious condition and often a diagnosis of exclusion. Current policy in the United Kingdom recommends management in primary care. We explored how patients with CFS/ME and family physicians understand this condition and how their understanding might affect the primary care consultation. METHODSWe undertook a qualitative study with patients and family physicians from North West England participating in a primary care-based randomized controlled trial (FINE Trial). Data were collected through purposive sampling and in-depth semistructured interviews with 24 patients and 14 family physicians. We analyzed interview transcripts using constant comparison methods. RESULTSFamily physicians access social and cultural knowledge to reach a clinical understanding of CFS/ME and its management. Patients recognize the diffi culties family physicians encounter in understanding their symptoms and access similar nonclinical sources of information. We suggest that both patients and physicians use biomedical discourse within the consultation: the physician to maintain the position as an expert, the patient to engage the physician. CONCLUSIONSFamily physicians obtain information about CFS/ME from their nonprofessional world, which they incorporate into their professional realm. Patients and physicians describe the use of the discourse of science within consultations about CFS/ME. This form of shared understanding could lead to a positive collaborative interaction. Family physicians need a biomedical, evidence-based knowledge about CFS/ME. There is potential to use the rich knowledge base that patients can bring to consultations in training initiatives directed at family physicians. Ann Fam Med 2008;6:340-348. DOI: 10.1370/afm.867. INTRODUCTIONC hronic fatigue syndrome (CFS), or myalgic encephalitis (ME), is a chronic incapacitating illness that leads to individual disability 1 and lost productivity. 2,3 The annual economic impact of chronic fatigue syndrome in the United States is estimated to be $9.1 billion in lost productivity, not including medical costs or disability payments. The average family affected by CFS/ME loses $20,000 a year in wages and earnings.1 Patients usually experience multiple additional symptoms, 4 commonly with comorbid psychiatric disorders. 5 Prognosis is poor 6 and is accompanied by functional impairment and reduced quality of life. 7 Persons with CFS/ME are high users of health care services and more likely than others to be out of work. 8 The diagnosis is surrounded by controversy. 9 Most researchers now accept the view that CFS/ME is multifactorial and distinguish among factors that predispose, precipitate, and perpetuate the condition. In 2002 the UK Department of Health recommended that CFS/ME should be managed wherever possible in the community by family physicians supported by local multidisciplinary teams. 11 In the absence of a fi rm evidence base for treatment of CFS/ME in primary care, this recommendation was ...

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“…We found descriptive reports of explanation types used by patients [38] and doctors [25] but none had the detailed two-level structure which we found necessary to classify the explanations in our studies. Two studies have described conversation analysis of consultations for medically unexplained symptoms [21,31].…”

Section: Comparison With Existing Researchmentioning

confidence: 90%

“…This taxonomy extends existing models of clinical explanation [25] by providing a unifying framework of structure and components. The taxonomy provides new insights into the way that different explanation types convey different messages about responsibility and agency in relation to symptoms.…”

Section: Summary Of Main Findingsmentioning

confidence: 93%

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A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

Morton

Elliott

Cleland

et al. 2017

Patient Education and Counseling

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Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation

Cited by 135 publications

References 102 publications

Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

Using Multiple Sources of Knowledge to Reach Clinical Understanding of Chronic Fatigue Syndrome

A taxonomy of explanations in a general practitioner clinic for patients with persistent “medically unexplained” physical symptoms

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