How General Practitioners Raise Psychosocial Concerns as a Potential Cause of [MUS]: A Conversation Analysis, Stortenbeker et al, 2021

[Andy]

Full title: How General Practitioners Raise Psychosocial Concerns as a Potential Cause of Medically Unexplained Symptoms: A Conversation Analysis

A common explanation for medically unexplained symptoms (MUS) relates patients’ psychosocial concerns to their physical ailments. The present study used conversation analysis to examine how general practitioners (GPs) ascribe psychosocial causes to patients’ unexplained symptoms during medical consultations. Our data consisted of 36 recorded consultations from Dutch general practice. We found that GPs raise psychosocial concerns as a potential cause of MUS in 14 consultations, either captured in 1) history-taking questions, or 2) diagnostic explanations. Whereas questions invited patient ideas, explanations did not make relevant patient responses in adjacent turns and subordinated patients’ knowledge in symptom experiences to the GP’s medical expertise. By questioning patients whether their symptoms may have psychosocial causes GPs enabled symptom explanations to be constructed collaboratively. Furthermore, additional data exploration showed that GPs lay ground for psychosocial ascriptions by first introducing psychosocial concerns as a consequence rather than a cause of complaints. Such preliminary activities allowed GPs to initiate rather delicate psychosocial ascriptions later in the consultation.

Open access, https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1864888

 

[Sean]

GPs lay ground for psychosocial ascriptions by first introducing psychosocial concerns as a consequence rather than a cause of complaints.

How to build a trusting relationship with your patients. Not.

Do these guys ever think through the real consequences of what they are doing?

 

[Mithriel]

I have no problem with doctors asking if someone is having problems in life or any problems with their mental health. It is when they do not accept the answer that I get angry. Too often saying "no" is taken to mean the patient is in denial so is "expressing emotional problems as physical symptoms".

 

[mat]

This is consistent with my own experiences. When a patient has multiple vague symptoms, they get psychological suspicions. In my country, there is also a course or training that is offered to many practitioners. It is called "psychosomatic training". I wonder what they get trained there. Probably how to recognize certain trigger keywords and how to ask the patient things that ultimately make them a "psychosomatic case". IMHO, this training should be prohibited. I guess their basis is a mix of homeopathy research and the research as how you can find it in the CFS field.

 

[rvallee]

Like I said: false attribution syndrome.

No one seems to ask the question of whether this is of any use whatsoever, it's simply assumed to be. It clearly isn't useful other than as an excuse not to do their job, hence why the awkward question isn't asked.

By questioning patients whether their symptoms may have psychosocial causes GPs enabled symptom explanations to be constructed collaboratively

A few words could be swapped and this could describe the process by which fortune tellers "collaboratively" build a narrative with their client, "personalized" of course. There is no reason to believe this is a useful process when all it does is falsely ascribe cause to something that isn't even relevant.

 

[alktipping]

yes it was the emotion of being shot in my leg that is causing my leg to hurt and bleed all over your lovely carpet now can you do your damn job and stitch it up .