Lost in fragmentation — care coordination when somatic symptoms persist: a qualitative study of patients’ experiences, 2022, Barends et al

[Andy]

Background
GPs can play a central role in the care of patients with persistent somatic symptoms (PSS). To date, little is known about these patients’ experiences relating to their coordination of care.

Aim
To explore the experiences of patients with PSS relating to coordination of care — in particular by their GP — during their illness trajectory.

Design and setting
This qualitative study was carried out from January to April 2019 in the Netherlands as part of a multicentre prospective cohort study on the course of PSS (PROSPECTS).

Method
Thematic content analysis of 15 interviews.

Results
Three themes were identified: care fragmentation during the diagnostic trajectory; transition from the search for a cure to coping; and reframing to coping: GPs’ role in facilitating supportive care. Patients experienced a lack of collaboration from healthcare workers during the diagnostic trajectory. Guidance by their GP in a process of shared decision making was positively valued by patients. Moving the focus from searching for a cure to coping with symptoms was described as a ‘personal endeavour’, made even more challenging by the ongoing uncertainty experienced by patients. When reframing to coping, the extent to which patients felt aligned with their GP played an important role in whether their supportive care request was met.

Conclusion
Patients experienced difficulties when navigating the diagnostic trajectory and shifting to coping. The findings of this study underline the importance of collaboration between GPs and other healthcare professionals during the diagnostic trajectory. The authors recommend that GPs provide proactive guidance and are sensitive to patients who shift to coping by providing them with supportive care in a process of shared decision making.

Open access, https://bjgp.org/content/early/2022/09/19/BJGP.2021.0566

 

[rvallee]

To date, little is known about these patients’ experiences relating to their coordination of care.

Their what now? Is it at the same place as all the free ponies and secondary benefits we all get?

The authors recommend that GPs provide proactive guidance

Out of what hat are they going to pull that? Basically: just wing it. Yeah, that'll do it. Wear the white coat, put on a solemn expression, hold their hands and declare "it's healing time!"

Good grief just stop whining about how hard it is and just do the damn work (or ideally step aside and let competent people do it). At this point it's literally been more work to fabricate excuses than to do it in the first place. It's not as if decades of myth-building were ever going to amount to anything more than a collection of "we used to say that but now we still mean it we just don't say it out loud".

 

[Art Vandelay]

Patients experienced difficulties when navigating the diagnostic trajectory and shifting to coping. The findings of this study underline the importance of collaboration between GPs and other healthcare professionals during the diagnostic trajectory. The authors recommend that GPs provide proactive guidance and are sensitive to patients who shift to coping by providing them with supportive care in a process of shared decision making.

Translation:

We spoke to a group of patients who had been told that their unexplained physical symptoms were created by their inappropriate thoughts and beliefs. They were told the cure was to "stop thinking incorrectly" and to "suck it up, buttercup".

While lesser mortals with common sense may conclude that this explanation is wildly speculative and pseudoscientific, those of us in medicine strongly believe in it because it was contained in a psychiatry textbook on hysteria we were forced to memorise at medical school and it reinforces our smug feelings of superiority.

Inexplicably, these patients were dissatisfied with the quality of healthcare they were receiving. We advise that their GPs speak to them in a more condescending and dismissive manner until they give up on monopolising scarce resources.