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Communication interventions for medically unexplained symptom conditions in general practice: A systematic review 2022 Byrne et al

Discussion in 'Other psychosomatic news and research' started by Andy, Nov 15, 2022.

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  1. Andy

    Andy Committee Member

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    18,585
    Location:
    Hampshire, UK
    Abstract

    Background
    Medically unexplained symptoms (MUS) account for 3–50% of all General Practitioner (GP) consultations and are difficult to diagnose due to their unknown aetiology, symptom overlap between conditions, and lack of effective treatment options. MUS patients’ and primary care clinicians frequently face challenges during consultations, with GPs reporting difficulty identifying and classifying MUS, whilst patients report stigma and feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS.

    Aim
    This systematic review aims to evaluate the effectiveness of primary care based communication interventions at improving MUS patients’ and/or clinician outcomes.

    Method
    Four electronic databases were searched from inception to November 2021. Two researchers independently undertook screening, data extraction and quality appraisal. Given the heterogeneous nature of the studies identified, narrative syntheses were conducted, along with meta-analyses where possible to pool data.

    Results
    9 papers from 10 Randomised Controlled Trials were included. The included studies displayed considerable risk of bias and poor reporting. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (such as reattribution) could improve pain, mental and physical functioning whilst reattribution training may improve clinician confidence treating MUS. However, methodological limitations mean that these findings should be interpreted with caution.

    Conclusion
    A range of interventions for improving communication with MUS patients in primary care have been evaluated. However, the heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. Before considering further randomised controlled trials researchers should focus on developing a new or modified communication intervention for MUS patients and their clinicians.

    Open access, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277538
     
  2. Cheshire

    Cheshire Moderator Staff Member

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    4,674
    The first step to improve communication could be to throw away the whole concept of MUS and all its avatars.
     
    Last edited: Nov 15, 2022
  3. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    10,169
    Location:
    Canada
    None of this is a communication problem. Communication is not an intervention anyway , especially when you don't understand what's happening, obviously no one can communicate what they don't know. The level of nonsense here is absurd. I guess by communication they mean rhetoric, which is not communication at all.

    Somehow it's still their conclusion. Amazing. It's like the entire process is devoid of any learning.
     
  4. bobbler

    bobbler Senior Member (Voting Rights)

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    1,077

    This is a laugh. The first line of claiming MUS accounts for 5-30% (and that often changes upwards to 50% in some CCG documents) of all GP appointments is in itself a demonstration of a communication problem this lot are happy to overlook because it is 'the wrong way'.

    I don't believe for a second this is about fixing patients communicating well and the 'listening to understand' job that anyone in a conversation is obliged to do being dropped by the GP because BPS and pathways from certain quarters have insisted they've made a decision on what that patient will be based on what they want to offer them (or not offer them) before they've even opened their mouth.

    So if they aren't addressing that why on earth they expect patients to listen to nonsense based on nonsense nonscience I don't know. The sad thing is that taxpayers are clearly paying a fortune for this nonsense to be repeated in up to half of all appointments, for the only end result of brainwashing the sayer (which is what making someone repeat something many times does) e.g. the GP - who by the way will generally become 'the buyer' (given how CCGs worked). All in the name of someone somewhere's business model.

    This really is now into propaganda and manifesto territory where I assume this whole 'article' has only been written in order to fulfil the make sure the misinformation in the first line is read by all GPs 7 times in a month in order to reach the optimal advertising frequency so they believe that "30% of their patients walking through their door will have 'MUS'". Even though it is a pretend illness, and is basically bigotry to bucket people out of access to services based only on demographics.

    It is in the sheer meaning of the sentence logically priming/giving the order to GPs to assume 30% of people will be 'unexplained' ergo: for 3 in 10 people walking through your door we expect you to not investigate or do medicine, in order to hit that quota.

    Could you imagine if all car repair/MOT garages pushed the same required quota: that 30% of cars coming in were to be categorised as 'unexplained' best treated by not lifting the bonnet and assuming there is nothing wrong. Treated by gaslighting the drivers that they were imagining it not starting or having a rattling sound or overheating. And suggesting that if customers were not taking this on board as a paradigm then better communication of that 'it's in your head' was what was needed, rather than someone investigating said cars, maybe having a register to report certain issues along with make/model to see if there are common issues etc.
     
    Last edited: Nov 16, 2022
    rvallee, Cheshire and Sean like this.
  5. Sean

    Sean Senior Member (Voting Rights)

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    Location:
    Australia
    Still stuck in the sales pitch is the problem phase.
     
  6. NelliePledge

    NelliePledge Moderator Staff Member

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    10,967
    Location:
    UK West Midlands
    The people who need the intervention are those still pumping out this tripe.
     
  7. ToneAl

    ToneAl Established Member (Voting Rights)

    Messages:
    72
    Location:
    Adelaide Australia
    The whole MUS ideology is that of cost and time. Fewer tests and ĺimited appointments.
    The whole cut of points regarding pathology tests could also be examined
     

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