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

Abstract

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

Management of Functional Somatic Syndromes and Bodily Distress

“…Initially and in uncomplicated cases, an encompassing biopsychosocial attitude, a focus on symptomatic relief, patient activation, and avoidance of iatrogenic harm is particularly helpful. In more chronic and/or severe cases, management works best when not only the patients but also their doctors achieve a reframing of the clinical problem: from cure to care and coping, from classical biomedical explanations to a broader view of biologically and psychosocially aggravating and alleviating factors [79]. Importantly, this reframing from cure to care and coping is also necessary for mental health specialists and psychotherapists, as is the switch from classical psychosocial explanations to such a broader view of biopsychosocial modulators.…”

Careful expressions of social aspects: How local professionals in high school settings, municipal services, and general practice communicate care to youth presenting persistent bodily complaints

“…Our findings may expand the uses of such insights to other professions and care settings and illustrate the powerful role played by medical imaginaries and frameworks in more settings than the clinic. Still experiencing conceptual incongruence (May et al, ) in relation to their explanatory models in these encounters, the professionals in our study invest in care alliances, or ‘relational congruence,’ to build a foundation for solving communicative dilemmas at later stages (Johansen & Risør, , p. 652).…”

“…A recurring theme in both medical and social research is clinicians’ dilemmas when attempting to understand, explain, and recognise suffering that is poorly expressed within a dominant reductionist biomedical framework and language (Jutel, ; Kirmayer, ). These dilemmas are illuminated in research on general practitioners (GPs) struggling to express psychosocial aspects and reconcile incongruent explanatory models with adult patients (Johansen & Risør, ; Van Ravenzwaaij et al, ). They are also reflected in research on clinical communication with youth (Buchbinder, ; Geist, Weinstein, Walker, & Campo, ; Hareide, Finset, & Wyller, ) showing negative perceptions attributed to psychosocial explanations.…”

Symptom management for medically unexplained symptoms in primary care: a qualitative study

“…[2][3][4][5] Under current guidelines, GPs have a central position in the care of patients with MUS. [6][7][8] Though GPs agree that patients with MUS should be managed in primary care, many perceive these patients to be difficult, [9][10][11] with a dilemma over whether or not to pursue further diagnostic evaluations. GPs often feel pressurised to undertake or refer for further diagnostic testing, but studies show that it may be the GPs themselves and not the patients who initiate these strategies.…”

“…A recent meta-synthesis of qualitative studies on management of patients with MUS in primary care identified 13 studies, all based on focus groups and interviews. 17 These studies mainly focused on explanations and relational aspects, and thus lacked information on GPs' actions with regard to stimulating symptom management. The few observational studies available focused on the topic of somatic interventions.…”