The challenge of diagnosing non-specific, functional, and somatoform disorders: A systematic review of barriers to diagnosis in primary care

Murray, Alexandra; Toussaint, Anne; Althaus, Astrid; Löwe, Bernd

doi:10.1016/j.jpsychores.2015.11.002

Cited by 114 publications

(115 citation statements)

References 62 publications

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“…For doctors who are trained to work on the basis of evidence-based biomedical knowledge and technological proof, somatic symptoms unsubstantiated by observable biomarkers to verify organic disease are challenging. When their ability to identify, explain and treat patients’ ailments is constrained by an uncertain biomedical foundation, they often feel powerless, inadequate, dissatisfied, frustrated and anxious (Åsbring & Närvänen, 2003; Chew-Graham, Cahill, Dowrick, Wearden, & Peters, 2008; Chew-Graham, Dowrick, Wearden, Richardson, & Peters, 2010; Howman, Walters, Rosenthal, Ajjawi, & Buszewicz, 2016; Libert et al, 2016; Murray, Toussaint, Althaus, & Löwe, 2016). For patients, experiences of uncertainty can increase psychological distress, intensify sensitivity to pain (Rosendal et al, 2013; Taylor, Marshall, Mann, & Goldberg, 2012; Weiland et al, 2012; Wright, Afari, & Zautra, 2009), and result in poorer health (Neville, 2003), reduced quality of life and diminished confidence (Ogden et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Lian

Robson

2017

International Journal of Qualitative Studies on Health and Well

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Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.

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Section: Introductionmentioning

confidence: 99%

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Lian

Robson

2017

International Journal of Qualitative Studies on Health and Well

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“…This dualism entails a dominance of the biomedical disease model, which is a barrier to diagnosing people suffering from persistent unexplained symptoms [40]). However, "in general practice, biomedical reductionism is ultimately impossible" [20] p. 12.…”

Section: Discussionmentioning

confidence: 99%

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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“…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. Indeed, a number of the ways in which our participants used the term difficult to describe their experiences, relate to a number of these 'barriers' as can be seen in Figure 4.…”

Section: Discussionmentioning

confidence: 99%

“…'(difficult) psychophysiology' or '(difficult) health care systems'. But, as some of these external difficulties, especially medical culture or "medical ideology" as Murray et al call it [66], are slow to change and hard to alter, and the fact that inevitably medicine will never be fully capable of understanding and relieving all forms of human suffering, we believe it is crucial to address experiential, emotional or personal difficulty as its own reality. This aspect is easily neglected in the literature and we believe it is one of the strengths of primary, qualitative research like our study to draw attention to such neglected perspectives and experiences.…”

Section: Discussionmentioning

confidence: 99%

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

Maatz¹,

Wainwright

Russell

et al. 2016

Journal of Psychosomatic Research

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Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. AbstractBackground The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS.

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The challenge of diagnosing non-specific, functional, and somatoform disorders: A systematic review of barriers to diagnosis in primary care

Cited by 114 publications

References 62 publications

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

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

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

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