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Nagel C, Queenan C, Burton C. What are medical students taught about persistent physical symptoms? A scoping review of the literature. BMC MEDICAL EDUCATION 2024; 24:618. [PMID: 38835003 DOI: 10.1186/s12909-024-05610-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Persistent Physical Symptoms (PPS) include symptoms such as chronic pain, and syndromes such as chronic fatigue. They are common, but are often inadequately managed, causing distress and higher costs for health care systems. A lack of teaching about PPS has been recognised as a contributing factor to poor management. METHODS The authors conducted a scoping review of the literature, including all studies published before 31 March 2023. Systematic methods were used to determine what teaching on PPS was taking place for medical undergraduates. Studies were restricted to publications in English and needed to include undergraduate medical students. Teaching about cancer pain was excluded. After descriptive data was extracted, a narrative synthesis was undertaken to analyse qualitative findings. RESULTS A total of 1116 studies were found, after exclusion, from 3 databases. A further 28 studies were found by searching the grey literature and by citation analysis. After screening for relevance, a total of 57 studies were included in the review. The most commonly taught condition was chronic non-cancer pain, but overall, there was a widespread lack of teaching and learning on PPS. Several factors contributed to this lack including: educators and learners viewing the topic as awkward, learners feeling that there was no science behind the symptoms, and the topic being overlooked in the taught curriculum. The gap between the taught curriculum and learners' experiences in practice was addressed through informal sources and this risked stigmatising attitudes towards sufferers of PPS. CONCLUSION Faculties need to find ways to integrate more teaching on PPS and address the barriers outlined above. Teaching on chronic non-cancer pain, which is built on a science of symptoms, can be used as an exemplar for teaching on PPS more widely. Any future teaching interventions should be robustly evaluated to ensure improvements for learners and patients.
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Affiliation(s)
- Catie Nagel
- Primary Care Research Group, Division of Population Health, School of Medicine, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK.
| | - Chloe Queenan
- Primary Care Research Group, Division of Population Health, School of Medicine, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK
| | - Chris Burton
- Primary Care Research Group, Division of Population Health, School of Medicine, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK
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Thursby S, Dismore L, Swainston K. Clinical skills development for healthcare practitioners working with patients with persistent physical symptoms (PPS) in healthcare settings: a systematic review and narrative synthesis. BMC MEDICAL EDUCATION 2024; 24:328. [PMID: 38519955 PMCID: PMC10960475 DOI: 10.1186/s12909-024-05306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The complexity and uncertainty around Persistent Physical Symptoms (PPS) make it difficult to diagnose and treat, particularly under time-constrained consultations and limited knowledge. Brief interventions that can be utilised in day-to-day practice are necessary to improve ways of managing PPS. This review aimed to establish (i) what training primary and secondary healthcare practitioners have undertaken to develop their clinical skills when working with PPS, (ii) what training techniques or theoretical models have been used within these interventions, and (iii) how effective was the training. METHOD A systematic literature search was undertaken on eight databases to identify professional development interventions for healthcare practitioners working with PPS, were of any study design, and at a minimum were single measure studies (i.e., training outcome alone). Studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and narratively synthesised. RESULTS Despite high methodological heterogeneity across the six included studies, they all aimed to improve healthcare practitioners' communication skills through educational (theory, awareness, attitudes, assessment, treatment, and management of PPS) and experiential (role play) learning. CONCLUSIONS The review findings demonstrate that developing healthcare practitioners' communicative behaviours led to increased confidence and self-efficacy when working with PPS, which facilitated improved consultations and improvements on some patient outcomes. Barriers to the uptake of training programmes and implementation into daily clinical practice are discussed, including the need for PPS to be formally implemented into undergraduate teaching and post-qualification continuous professional development. TRIAL REGISTRATION This review was registered at PROSPERO [CRD42022315631] prior to the review starting.
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Affiliation(s)
- Stacie Thursby
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Katherine Swainston
- Faculty of Medical Sciences, School of Psychology, Newcastle University, 4 Floor Dame Margaret Barbour Building, Wallace Street, Newcastle Upon Tyne, NE1 7RU, England.
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Mariman A, Vermeir P, Csabai M, Weiland A, Stegers-Jager K, Vermeir R, Vogelaers D. Education on medically unexplained symptoms: a systematic review with a focus on cultural diversity and migrants. Eur J Med Res 2023; 28:145. [PMID: 37013665 PMCID: PMC10069028 DOI: 10.1186/s40001-023-01105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Health care providers often struggle with the management of patients with medically unexplained symptoms (MUS), especially in case of a different ethnicity and/or cultural background. These challenges are insufficiently addressed in their training. OBJECTIVES A systematic review on education in the field of MUS in a diverse context to improve MUS healthcare provider-patient interaction focused on intercultural communication. METHODS Screening of PubMed, Web of Science, Cinahl and Cochrane Library on the keywords 'Medical unexplained (physical) symptoms (MUS)', 'Somatoform disorder', 'Functional syndrome', 'Diversity', 'Migrants', 'Ethnicity', 'Care models', 'Medical education', 'Communication skills', 'Health literacy'. RESULTS MUS patients, especially with a different ethnic background, often feel not understood or neglected. Health care providers experience feelings of helplessness, which may provoke medical shopping and resource consumption. Attitudes and perceptions from undergraduate trainees to senior physicians tend to be negative, impacting on the quality of the patient/health care provider relationship and subsequently on health outcomes, patient satisfaction and therapeutic adherence. Current undergraduate, graduate and postgraduate education and training does not prepare health care providers for diagnosing and managing MUS patients in a diverse context. A continuum of training is necessary to achieve a long term and lasting change in attitudes towards these patients and trainers play a key role in this process. Hence, education should pay attention to MUS, requiring a specific competency profile and training, taken into account the variety in patients' cultural backgrounds. CONCLUSIONS This systematic review identified significant gaps and shortcomings in education on MUS in a diverse context. These need to be addressed to improve outcomes.
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Affiliation(s)
- An Mariman
- Faculty of Medicine and Healthcare Sciences, Ghent University, Ghent, Belgium
- Centre for Integrative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter Vermeir
- Faculty of Medicine and Healthcare Sciences, Ghent University, Ghent, Belgium.
- Dean's Office of the Faculty of Medicine and Healthcare Sciences, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Marta Csabai
- Institute of Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Anne Weiland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Karen Stegers-Jager
- Institute of Medical Education Research, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ruben Vermeir
- Faculty of Medicine and Healthcare Sciences, Ghent University, Ghent, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Healthcare Sciences, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Department of General Internal Medicine, AZ Delta, Roeselare, Belgium
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Cheston K. (Dis)respect and shame in the context of 'medically unexplained' illness. J Eval Clin Pract 2022; 28:909-916. [PMID: 35899324 PMCID: PMC9796720 DOI: 10.1111/jep.13740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Abstract
A significant proportion of somatic symptoms remain, at present, medically unexplained. These symptoms are common, can affect any part of the body, and can result in a wide range of outcomes-from a minor, transient inconvenience to severe, chronic disability-but medical testing reveals no observable pathology. This paper explores two first-person accounts of so-called 'medically unexplained' illness: one that is published in a memoir, and the other produced during a semi-structured interview. Both texts are revelatory for their expression of shame in the context of encountering disrespect from healthcare professionals. The first section of my paper, clinical encounters, explores disrespect which, I argue, takes three interconnecting forms in these texts: disrespect for pain when it is seen as 'medically unexplained', disrespect for the patient's account of her own pain, and disrespect for the patient herself. The second section elucidates the shame that occurs as an affective and embodied consequence of encountering such disrespect. I claim that patients living with so-called 'medically unexplained' illnesses suffer a double burden. They endure both somatic and social suffering-not only their symptoms, but also disrespectful, traumatic and shame-inducing experiences of healthcare systems. I conclude with a reflection on the urgent need for changes in clinical training that could improve the quality of life for these patients, even in the absence of an explanation, treatment or cure for their symptoms.
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Houwen J, de Bont OA, Lucassen PL, Rosmalen JGM, Stappers HW, Olde Hartman TC, van Dulmen S. Development of a blended communication training program for managing medically unexplained symptoms in primary care using the intervention mapping approach. PATIENT EDUCATION AND COUNSELING 2022; 105:1305-1316. [PMID: 34561144 DOI: 10.1016/j.pec.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND General practice (GP) training in how to communicate with patients with medically unexplained symptoms (MUS) is limited. OBJECTIVE Development, implementation and evaluation of an evidence-based communication training program for GP residents focused on patients with MUS in primary care. METHODS We used the intervention mapping (IM) framework to systematically develop the MUS training program. We conducted a needs assessment to formulate change objectives and identified teaching methods for a MUS communication training program. Next, we developed, implemented and evaluated the training program with 46 residents by assessing their self-efficacy and by exploring their experiences with the training. RESULTS The resulting program is a blended training with an online course and two training days. After attending the training program, GP residents reported significantly higher self-efficacy for communication with patients with MUS at four weeks follow up compared to baseline. Furthermore, GP residents experienced the training program as useful and valued the combination of the online course and training days. CONCLUSION AND PRACTICE IMPLICATIONS We developed an evidence-based communication training program for the management of patients with MUS in primary care. Future research should examine the effect of the training on GP residents' communication skills in MUS consultations in daily practice.
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Affiliation(s)
- Juul Houwen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Olga A de Bont
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Peter Lbj Lucassen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Judith G M Rosmalen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Hugo W Stappers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
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Sallay V, Martos T, Lucza L, Weiland A, Stegers-Jager KM, Vermeir P, Mariman ANM, Csabai M. Medical educators' experiences on medically unexplained symptoms and intercultural communication-an expert focus group study. BMC MEDICAL EDUCATION 2022; 22:310. [PMID: 35461231 PMCID: PMC9034474 DOI: 10.1186/s12909-022-03275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. METHODS Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. RESULTS Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. CONCLUSIONS The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
| | - Tamás Martos
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary.
| | - Lilla Lucza
- Doctoral School of Education, University of Szeged, Szeged, Hungary
| | - Anne Weiland
- Department for Internal Medicine & General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Peter Vermeir
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
| | - An Noelle Margareta Mariman
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Center for Integrative Medicine, Ghent, Belgium
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
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7
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Goutte J, Cathébras P. Attitudes of internal medicine specialists and rheumatologists towards chronic pain complaints. Int J Clin Pract 2021; 75:e14463. [PMID: 34535053 DOI: 10.1111/ijcp.14463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Julie Goutte
- Internal Medicine Department & Jean-Monnet University, University Hospital (Hôpital Nord), Saint-Etienne, France
| | - Pascal Cathébras
- Internal Medicine Department & Jean-Monnet University, University Hospital (Hôpital Nord), Saint-Etienne, France
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8
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Houwen J, Lucassen PLBJ, Stappers HW, van Spaendonck K, van Duijnhoven A, Hartman TCO, van Dulmen S. How to learn skilled communication in primary care MUS consultations: a focus group study. Scand J Prim Health Care 2021; 39:101-110. [PMID: 33569982 PMCID: PMC7971340 DOI: 10.1080/02813432.2021.1882088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many general practitioners (GPs) experience communication problems in medically unexplained symptoms (MUS) consultations as they are insufficiently equipped with adequate communication skills or do not apply these in MUS consultations. OBJECTIVE To define the most important learnable communication elements during MUS consultations according to MUS patients, GPs, MUS experts and teachers and to explore how these elements should be taught to GPs and GP trainees. METHODS Five focus groups were conducted with homogeneous groups of MUS patients, GPs, MUS experts and teachers. MUS patients and GPs formulated a list of important communication elements. MUS experts identified from this list the most important communication elements. Teachers explored how these elements could be trained to GPs and GP trainees. Two researchers independently analysed the data applying the principles of constant comparative analysis. RESULTS MUS patients and GPs identified a list of important communication elements. From this list, MUS experts selected five important communication elements: (1) thorough somatic and psychosocial exploration, (2) communication with empathy, (3) creating a shared understanding of the problem, (4) providing a tangible explanation and (5) taking control. Teachers described three teaching methods for these communication elements: (1) awareness and reflection of GPs about their feelings towards MUS patients, (2) assessment of GPs' individual needs and (3) training and supervision in daily practice. CONCLUSION Teachers consider a focus on personal attitudes and needs, which should be guided by opportunities to practice and receive supervision, as the best method to teach GPs about communication in MUS consultations.KEY POINTSMany GPs experience difficulties in communication with patients with MUS.There is a need to equip GPs with communication skills to manage MUS consultations more adequately.Role-playing with simulation patients, reflection on video-consultations and joint consultations with the supervisor may increase the GPs' awareness of their attitude towards MUS patients and may help GPs to identify their individual learning-points.
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Affiliation(s)
- Juul Houwen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- CONTACT Juul Houwen Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Geert Grooteplein, 21, Nijmegen6525 EZ, The Netherlands
| | - Peter L. B. J. Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hugo W. Stappers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karel van Spaendonck
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aniek van Duijnhoven
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim C. olde Hartman
- Department of Primary and Community Care, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Georghiades A, Eiroa-Orosa FJ. A systematic review outlining the impact of education on patients and physicians in gastroenterology. PSYCHOL HEALTH MED 2021; 27:1468-1481. [PMID: 33632021 DOI: 10.1080/13548506.2021.1890158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Functional gastrointestinal symptoms (FGIDs) refer to a noticeable change in the body that is reported by the patient as being different from normal. FGIDs can have a significant impact on the patient's quality of life by interfering with daily functioning. The primary objective of the current paper was to identify short-term educational interventions for patients diagnosed with FGIDs and medically unexplained symptoms. This is with the aim of assessing its effectiveness on patient's quality of life and symptom severity. The second objective was to establish the current educational programmes and training opportunities available for physicians working with this subgroup of patients. This is in order to ascertain if these could change negative physician beliefs and attitudes. Databases such as PubMed and Google Scholar were searched from November to February 2018. A total of eight interventions were found which were evaluated using the Behavioural Change Techniques Taxonomy. Short-term educational programmes combining the use of lectures and practical sessions were found to be the most effective in improving patient quality of life and symptom severity. Managing patient exposure through the use of problem-based learning was considered the most effective teaching method for trainee physicians and could help to prevent the internalisation of negative attitudes. Definite conclusions about the effectiveness of patient and physician interventions are difficult to ascertain due to the small number of studies found and the high risk of bias. Future research should focus on providing a more unified approach to the management of this subgroup of patients.
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Affiliation(s)
- Alicia Georghiades
- Section of Personality, Evaluation and Psychological Treatment; Department of Clinical Psychology and Psychobiology; School of Psychology; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Francisco José Eiroa-Orosa
- Section of Personality, Evaluation and Psychological Treatment; Department of Clinical Psychology and Psychobiology; School of Psychology; Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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Kline JA, Lin MP, Hall CL, Puskarich MA, Dehon E, Kuehl DR, Wang RC, Hess EP, Runyon MS, Wang H, Courtney DM. Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging. J Patient Exp 2020; 7:386-394. [PMID: 32821799 PMCID: PMC7410137 DOI: 10.1177/2374373519838529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Lack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED). METHODS Multicenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education. RESULTS We enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compared with white patients, nonwhite patients had similar JSPPPE and TIPS scores but had higher (worse) GBMMS scores. Females had significantly lower JSPPPE and TIPS scores than males, and scores were lower (worse) in females with college degrees. Patients in the lowest tier of educational status had the highest (better) JSPPPE and TIPS scores. Scores were invariant with physician characteristics. CONCLUSION Among patients undergoing low-value CT scanning in the ED, the degree of patient perception of physician empathy and trust varied based on the patients' level of education and gender. Given this variation, an intervention to increase patient perception of physician empathy should contain individualized strategies to address these subgroups, rather than a one-size-fits-all approach.
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Affiliation(s)
- Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michelle P Lin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cassandra L Hall
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Erin Dehon
- Department of Emergency Medicine, University of Mississippi, Jackson, MS, USA
| | - Damon R Kuehl
- Department of Emergency Medicine, Virginia Tech-Carilion, Roanoke, VA, USA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, CA, USA
| | - Erik P Hess
- Department of Emergency Medicine, University of Alabama, Birmingham, AL, USA
| | - Michael S Runyon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Hospital, Ft. Worth, TX, USA
| | - D Mark Courtney
- Department of Emergency Medicine, Northwestern University School of Medicine, Chicago, IL, USA
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11
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Poloni N, Ielmini M, Caselli I, Ceccon F, Bianchi L, Isella C, Callegari C. Medically Unexplained Physical Symptoms in Hospitalized Patients: A 9-Year Retrospective Observational Study. Front Psychiatry 2018; 9:626. [PMID: 30532714 PMCID: PMC6265408 DOI: 10.3389/fpsyt.2018.00626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: "Medically Unexplained Physical Symptoms" (MUPS) defines a subgroup of patients presenting physical symptoms of unclear origin. The study aims to profile clinical and socio-demographic characteristics of patients with MUPS. Materials and Methods: This 9-years observational retrospective study assesses all patients admitted between 2008 and 2016 in the divisions of neurology and gastroenterology. Socio-demographic and clinical variables were evaluated: gender, age, diagnosis or diagnostic hypothesis, presence of psychiatric comorbidities, psychiatric evaluation, pharmacological treatment, number of admissions/visits. Results: Among 2,479 neurological patients 10.1% presented MUPS. Patients were more frequently women (63.5%), with a mean age of about 50 years. Reported symptoms were headache (22.6%), seizures (8.7%), vertigo (5.9%), fibromyalgia (5.5%), paresthesia (5.1%), visual disturbances (5.1%), amnesia (3.9%). The diagnosis was somatoform disorder in 6.3% of cases, conversion disorder in 2.7%, and somatic symptom disorder in 1.5% only. 2,560 outpatients were evaluated in gastroenterology division. 9.6% (n = 248) of patients had MUPS; 62.1% of them were women. The most affected age group ranged between 15 and 45 years. The most frequent diagnoses were functional abdominal pain (50%), dysmotility-like dyspepsia (26.6%), irritable bowel syndrome (10.4%), meteorism of unknown cause (2.4%), hiccup (1.6%), burning mouth syndrome (1.2%). No patients received a diagnosis of somatic symptom disorder. Discussion: Patients with MUPS are more often women, of middle age, with self-referred specific symptomatology. While neurological patients received a diagnostic-therapeutic approach in line with the literature, gastroenterological patients mainly received antipsychotics. A more comprehensive assessment and a development of psychoeducational interventions are needed to improve patients' quality and quantity of life.
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Affiliation(s)
| | | | | | | | | | | | - Camilla Callegari
- Section of Psychiatry, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Canavera K, Allen J, Johnson LM. The Need for Improved Access to Mental Health Services for Youth With Medically Unexplained Symptoms. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:29-31. [PMID: 29697336 DOI: 10.1080/15265161.2018.1445316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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13
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Finset A. Why do doctors not learn how to explain "medically unexplained symptoms"? PATIENT EDUCATION AND COUNSELING 2018; 101:763-764. [PMID: 29678266 DOI: 10.1016/j.pec.2018.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Arnstein Finset
- Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, Post Office Box 1111 Blindern, N-0317, Oslo, Norway.
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