Review Clinical skills development for healthcare practitioners working with patients with ... (PPS) in healthcare settings 2024 Thursby et al

Full title: Clinical skills development for healthcare practitioners working with patients with persistent physical symptoms (PPS) in healthcare settings: a systematic review and narrative synthesis

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.

Open access, https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05306-4

 

Selected quotes

"PPS represent a broad and heterogeneous spectrum of symptoms e.g., pain, headaches, dizziness, and conditions such as fibromyalgia, chronic fatigue, irritable bowel syndrome"

"Excessive and frequent healthcare utilisation of patients with PPS [4,5,6] puts this group of patients among the highest costing group within the National Health Service (NHS)"

"The lack of understanding of PPS often leads to patients undergoing inordinate levels of symptomatic investigation and medical intervention in biomedically-focused healthcare systems, increasing the risk of iatrogenic harm"

"Therefore, addressing these factors holistically is likely to improve health outcomes for patients thus improving clinical outcomes, reducing repeat consultations and medical costs."

 

Typically they will mean ME/CFS when they say chronic fatigue, especially if they also list conditions such as FM or IBS, so it is intentional inclusion.

One of the two references for that section of that paper says, "Medically unexplained physical symptoms (MUPS) include conditions characterized by subjective symptoms without corresponding objective findings [Citation1–3]. After adequate medical assessment, such symptom presentations may be for example asthenia, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, or chronic low back pain [Citation3]."

 

I wonder how much incorrect diagnosis will cost the health system. Save a penny, lose a pound.

My own Degenerative Disc Disease is costing more due to late diagnosis. I am physically shorter, the discs have turned from grapes to raisins if I may use a common analogy. The pain in my legs was blamed on restless leg syndrome and diabetes.

 

In the never-ending game of rebranding the same old ideas, the beliefs are no longer 'unhelpful', we're just too ignorant to understand them the way they do:

The premise here is clearly that psychosocial is good, more psychosocial is better, and that it mostly involves convincing patients that our issues are psychosocial. And of course they are completely oblivious that in reality it's the complete opposite, but their only solution, as is tradition, is to be more convincing about it, because psychosocial is good, and more psychosocial is better.