Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Gask, Linda; Dowrick, Christopher; Salmon, Peter; Peters, Sarah; Morriss, Richard

doi:10.1016/j.jpsychores.2011.05.008

Cited by 89 publications

(63 citation statements)

References 50 publications

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“…The BPS model seems to suggest a correction of patients' notions of pain and suffering, to make them realize that they have misinterpreted the level of location of their symptoms (ibid). This is parallel to longstanding empirical attempts of reattributing patients' physical symptoms to psychological causes [50]. Butler et al [49] suggest a more 'interpretivist' approach to support clinicians to help their patients 'make sense' of their symptoms, as what they are to them: 'a component of a person's interpretation or reaction to their situation in the world'.…”

Section: Discussionmentioning

confidence: 91%

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Johansen

Risør

2017

Patient Education and Counseling

101

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Please cite this article as: Johansen May-Lill, Risor Mette Bech.What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies.Patient Education and Counseling http://dx.doi.org/10.1016/j.pec. 2016.11.015 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Highlights:-For GPs, dominant disease models (biomedical or psychosocial) often do not fit with reality -Both patients and doctors struggle with and suffer from this incongruence -In the lack of congruent disease models, a validating doctorpatient relationship can be a lifeline 2 Abstract:Objective To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. MethodsWe used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. ResultsThe problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless. In the face of cognitive incongruence, GPs have strived to achieve relational congruence with their patients. This has led to parallel positive experiences of mutual trust and validation. With more experience, some GPs seem to overcome the incongruences, and later studies point towards a reframing of the MUS problem. ConclusionFor GPs, the challenge with MUS is most importantly at an epistemological level. Hence, a full reframing of the problem of MUS for GPs (and for patients) implies broad changes in basic medical knowledge and education. 3Practice Implications Short-term: Improve management of patients with MUS by transferring experience-based, reality-adjusted knowledge from senior GPs to juniors. Long-term: Work towards new models of disease that integrate knowledge from all relevant disciplines.199 words

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Section: Discussionmentioning

confidence: 91%

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

Johansen

Risør

2017

Patient Education and Counseling

101

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“…It is well known that discussing psychological reasons for feeling sick with patients is often experienced as challenging (24,25). In the context of the current zeitgeist, the social acceptance of "feeling sick" may be greater when symptoms are attributed to "burnout."…”

Section: Discussionmentioning

confidence: 99%

The Implications of Psychological Symptoms for Length of Sick Leave

Schneider¹,

Hilbert²,

Hamann³

et al. 2017

Deutsches Ärzteblatt International

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“…For example, in a series of studies (see Gask et al 2011) in which one of us was a major collaborator, British general practitioners were able to acquire a range of skills for the assessment and management of people presenting with medically unexplained symptoms which would, if applied, result in a more patient-centred consultation. These included learning how to pick up on cues relating to emotional distress, explore family and social issues with sensitivity and enquire about the meaning of particular physical symptoms to patients.…”

Section: Lessons From Researchmentioning

confidence: 99%

Person-centred mental health care: the challenge of implementation

Gask

Coventry

2012

Epidemiol Psychiatr Sci

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Within mental health care, 'person-centredness' has been generally interpreted to convey a holistic approach with an attitude of respect for the individual and his/her unique experience and needs. Although it has been possible to demonstrate that professionals can acquire such skills through training, the impact on clinical outcomes has been more difficult to demonstrate in randomized controlled trials. Indeed what is becoming increasingly apparent in the literature is the need to acknowledge and address the degree of complexity that exists within the health care system that militates against achieving satisfactory implementation and outcomes from person-centred mental health care. In addressing this, we must develop and work with more sophisticated and three-dimensional models of 'patient-centredness' that engage with not only what happens in the consulting room (the relationship between individual service users and healthcare professionals), but also addresses the problems involved in achieving person-centredness through modifying the way that services and organizations work, and finally by engaging families and communities in the delivery of health care. A truly meaningful concept of 'people-centredness' encompasses how the views of the population are taken into consideration not only in healthcare but also in health and social care policy, and wider society too.

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Reattribution reconsidered: Narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings

Cited by 89 publications

References 50 publications

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

What is the problem with medically unexplained symptoms for GPs? A meta -synthesis of qualitative studies

The Implications of Psychological Symptoms for Length of Sick Leave

Person-centred mental health care: the challenge of implementation

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