Experiences of general practitioners explaining central sensitisation to patients with persistent physical symptoms:, 2022, den Boer et al

Abstract

Objective
Patients with persistent physical symptoms (PPS) require an explanation that is acceptable and comprehensible to them. Central sensitisation (CS) is an explanatory model for PPS and chronic pain that has been broadly applied in the context of pain medicine, but, until recently, not by general practitioners (GPs). We explored how GPs used the CS model in their consultations with patients with PPS.

Design and setting
A qualitative focus group study among GPs in the Netherlands.

Methods
We instructed 33 GPs on how to explain CS to patients with PPS. After 0.5–1.5 years of using the CS model, 26 GPs participated in focus groups and interviews to report and discuss their experiences with CS as an explanatory model. Audio recordings were transcribed and two researchers independently analysed the data. The text was coded, codes were organised into themes and discussed until consensus was reached.

Results
We identified eleven themes and grouped these into four categories.

The GPs regarded the CS model as evidence-based, credible and giving recognition to the patient. On the other hand, they found explaining the CS model difficult and time-consuming. They tailored the CS model to their patients’ needs and used multiple consultations to explain the model. The GPs reported that the use of the CS model seemed to improve the understanding and acceptance of the symptoms by the patients and seemed to reduce their need for more diagnostic tests. Furthermore, patients seemed to become more motivated to accept appropriate therapy.

Conclusion
GPs reported that they were able to provide explanations with the CS model to their patients with PPS. They regarded the model as evidence-based, credible and giving recognition to the patient, but explaining it difficult and time-consuming.

Open access, https://bmjopen.bmj.com/content/12/7/e060063

 

No, patients want an explanation that accurately describes their condition and if that is not possible to be told ‘we don’t know’.

 

This is a twisted modern version of the Milgram experiment, except instead of random participants being asked to harm a stranger, it's physicians being asked to gaslight patients, which ultimately harms millions. They clearly have no issues with it, lying to patients is perfectly OK to them, as we can see. Which is the real alarming thing, but that's standard so not exactly a surprise.

I'm not sure things actually are any better than they were back then. They've taken all the wrong lessons out of it.

Also: an "explanatory model" sounds like religion to me, providing answers simply because it's what they do, even if that answer is made-up or unrelated to the actual questions. The Celestial sphere is an explanatory model, built on superficial observations. That's not a good thing, in fact it's explicitly bad pseudoscience.

And it's pretty ironic to pretend that the explanation is "tailored", when what they mean is exactly the way psychics use it. Medicine has grown way too comfortable with lying, and it's ruining the profession.

 

My answer to her post on LinkedIn. It's in Dutch but there's a translate button on LinkedIn

https://www.linkedin.com/feed/updat...Post:6957710275487662080,6957728396051156993)

 

This is also by her. Google translated.

 

Where is the translate button?

 

Hm apparently only in the app

Google translated:

She normally ignores my comments so I was surprised she answered:

 

GPs uncensored:

What a coincidence, patients think the same thing about GPs, pfffff.

O, so the explanation you're telling your patients is just misdirection (lie)?

A friend of mine died because of delayed diagnosis/treatment because they had a long history of mental illness (schizophrenia) and so their symptoms were simply dismissed.

 

Surely the approach recommended by a professional here (Jonathan) would be credible - I'm sorry I don't know

Taking the piss --- or is the proper term gaslighting? Surely treating the patient with respect would lead you to - I'm sorry I don't know
Potentially the Doctor could point out sites like this [Science 4 ME], highlight promising research like GWAS (and encourage participation) and explain that patient participation/lobbying is needed to get the research funding to make meaningful progress --- and the BMJ is highlighting the need for research --- not!