‘She thought the same way I that I thought:’ a qualitative study of patient-provider concordance among Gulf War Veterans with GWI 2023 Lesnewich et al

Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance—shared understanding between patient and provider about illness causes, course, and treatment—is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges.

Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data.

Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance.

Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients’ experiences, communicating knowledge about MUS, and establishing trust.

Keywords:

• Medically unexplained symptoms
• persistent physical symptoms
• chronic multisymptom illness
• somatization
• patient-provider communication
• goal concordant care

Paywall, https://www.tandfonline.com/doi/full/10.1080/08870446.2023.2248481

 

And then that trust will be lost once the patients figure out that the provider's expertise is illusionary and their theories are disguised patient blaming.

 

I feel like the trust gaining or demand is fundamental to why this approach is so dangerous. Imagine if they said to patients “look you’re a very naughty boy/girl” “reeducation or no dinner” straight up. They’d still be causing unimaginable suffering. They’d still be killing their patients. But its honest, and I think psychologically and emotionally their patients would feel better without the burden of having to pretend sadistic torture was treatment.

The ‘trust me I am an expert’ ‘come with me’ stuff is to my mind indistinguishable from a would be child abuser kidnapper or killer offering their intended victim, six year old lost child, some candy. And saying ‘shall I take you to mummy now?’

It is that creepy. It is that terrifying. But real stranger danger snatches aren’t a very common occurrence. Whereas misdiagnosis is very common. If that comes with some psychologising, or reluctance to change course on the part of the professional expert, it can be deadly.

I am thinking of all the premature deaths in our community and beyond.

 

They never seem to consider that part. Which makes me question whether they actually think it matters, since faking sincerity is, by definition, insincerity. Which makes me question, frankly, every single thing they say, since accuracy clearly does not matter. Their definition of trust is really compliance. Which is not trust at all. It's authority, and much closer to what is expected at churches.

But they have the benefit of a constant churn of patients so the loss of trust never matters. Well, they do complain about it a lot, but they don't understand that they're responsible for it. Can't seem to ever think about this as a possibility, even as they explicitly use a "build trust so you can better betray it" model.

 

Yes sir obedience.