Empirical Evaluation of Veterans’ Perceived Nonconcordance With Providers Regarding Medically Unexplained Symptoms, 2020, Phillips and McAndrew

Andy

Andy

Retired committee member
Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, yet this care may be influenced negatively by nonconcordance between veterans’ and providers’ views of MUS. We surveyed 243 veterans with MUS and evaluated the degree of nonconcordance perceived by veterans and their primary care providers regarding their MUS, as well as the effect of perceived nonconcordance on treatment behaviors and outcomes. Approximately 20% of veterans in our sample perceived nonconcordance with their provider regarding their MUS. In turn, perceived nonconcordance predicted important outcomes of interest, particularly veterans’ satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. We discuss future research directions for counseling psychologists.
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Paywall, https://journals.sagepub.com/doi/10.1177/0011000019890317
Sci hub, https://sci-hub.se/10.1177/0011000019890317
 
Wow, we are getting deep in the rabbit hole, of trying to apply voodoo maths to make a simple problem, of misdiagnosis and falsely attributing health problems to some imaginary psychology, more complex than it is based on a certainty over the MUS ideology, that they 100% represent psychological problems and that any claim that they are physical is itself evidence of false illness beliefs, with strength of conviction being the main factor of illness, because even without being cited Wessely is well represented here.
Veterans’ perceptions of nonconcordance regarding MUS overall. We directly asked veterans about perceived nonconcordance using the following question: “Do you and your primary care physician disagree about your MUS in general?” We asked veterans to rate their perceived nonconcordance with a 5-point Likert-type scale ranging from 1 (no disagreement/we completely agree) to 5 (we completely disagree). There were a large number of missing responses to this item (n = 59), perhaps because participants had a difficult time inferring what their providers’ views were.
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It is a core feature of the MUS approach to be deceitful to the patient and for physicians to not tell the patients directly that they think the symptoms are all psychosomatic. This takes a strong position that they obviously are psychological and that this is the only right answer. Nonconcordance here explicitly means falsely attributing health problems to a medical cause.

Some vague recommendations about building a therapeutic alliance, which is impossible when you are explicitly telling your patients complete BS. This is a US-based evaluation but it relies heavily on BPS research, with some familiar names like Moss-Morris, Chalder, Fink and Chew-Graham.

Basically following the growing theme of how to get people to agree that 2+2=5. Some people agree. Some disagree. What difference does it make? Ultimately none when it comes from an ideological position. There doesn't appear to be a point here other than frustration over why some people don't just agree with swallowing BS and trying to figure out how to better persuade.
 
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