Helpful ways providers can communicate about persistent medically unexplained physical symptoms

Abstract

BackgroundCommunication between patients and providers about persistent “medically unexplained” physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers. Veterans with GWI, a type of MUS, have historically had complex relationships with medical providers. Determining effective communication for patients with particularly complex relationships may help identify the most critical communication elements for all patients with MUS.MethodsTwo hundred and-ten veterans with GWI were asked, in a written questionnaire, what was the most useful thing a medical provider had told them about their GWI. Responses were coded into three categories with 10 codes.ResultsThe most prevalent helpful communication reported by patients was when the provider offered acknowledgement and validation (N = 70). Specific recommendations for managing GWI or its symptoms (N = 48) were also commonly reported to be helpful. In contrast, about a third of the responses indicated that nothing about the communication was helpful (N = 63). There were not differences in severity of symptoms, disability or healthcare utilization between patients who found acknowledgement and validation, specific recommendations or nothing helpful.ConclusionsPrevious research has documented the discord between patients and providers regarding MUS. This study suggests that most patients are able to identify something helpful a provider has said, particularly acknowledgement and validation and specific treatment recommendations. The findings also highlight missed communication opportunities with a third of patients not finding anything helpful.

Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990–1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study

“…Symptoms, by definition, are patients’ own experiences as opposed to externally “objective” measures of disease and have thus far been the only consistent marker of GWI in affected veterans. For many years, the lack of diagnosable abnormalities on physical exam and routine clinical lab tests commonly led to provider assumptions that nothing was wrong with veterans who reported chronic GWI symptoms, or that their health problems were the result of deployment stress and/or psychiatric in nature [ 48 , 49 , 50 ].…”

Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness

“…Instead, they often receive excessive healthcare [ 19 ], overly focused on diagnostic tests to determine the cause of the MUS [ 20 ]. Studies have found that individuals prefer explicit diagnoses such as chronic fatigue syndrome over the uncertainty of no diagnosis [ 53 ], and that they find acknowledgement and validation to be the most helpful communication from their provider [ 31 ]. How diagnosis for a MUS condition would influence Veterans’ care is unknown.…”

“…Participants were enrolled in a larger ( N = 268) interventional study examining the effectiveness of Problem-Solving Treatment to reduce disability for Veterans with Gulf War Illness [ 31 , 35 – 37 ]. To be eligible for the study, Veterans had to 1) deploy to Operation Desert Storm or Operation Desert Shield between August 1990 and November 1991, 2) meet the case definition for Gulf War Illness [ 2 ], and 3) report disability on the World Health Organization Disability Assessment Schedule (WHODAS 2.0) [ 38 ].…”

“…The MUS condition of Gulf War Veterans is typically termed Gulf War Illness, or Chronic Multisymptom Illness, and a case definition has been created which overlaps with other case definitions for MUS conditions [ 2 , 29 , 30 ]. Despite recognition from Congress, Veterans often report being frustrated that their MUS condition is not acknowledged by their providers and receiving limited disability benefits for their MUS condition [ 31 – 33 ]. Further, the military exposures that lead to MUS are under-recognize by providers [ 34 ].…”

Attitudes of internal medicine specialists and rheumatologists towards chronic pain complaints

“…These findings indicate an urgent need for improving knowledge of French medical specialists on bodily distress, and offering them trainings aimed at changing their representations of attitudes toward patients with persistent "unexplained" somatic symptoms. 9,10…”