Medical educators' experiences on medically unexplained symptoms and intercultural communication—an expert focus group study, 2022, Sallay et al

Abstract

Background

Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS.

Methods
Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions.

Results
Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices.

Conclusions
The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.

Open access, https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03275-0

 

"The term ‘medically unexplained symptoms’ (MUS) refers to various somatic complaints and syndromes (e.g., chronic fatigue, chronic pain, irritable bowel syndrome, and fibromyalgia) without somatic and/or psychiatric diagnosis sufficiently explaining the symptoms [1, 2]."

 

All this because doctors ego's are to frail to just admit that the profession does absolutely nothing to encourage research into areas where they have no working knowledge.

 

This is just plain weird. Medicine has a weird case of the "may be"s. Where if only the things they imagined were true, well, they would be true, I guess.

Why don't we just pay these people to stare at a wall instead? It would be more productive.

 

Tagging @Wyva due to this paper coming from Hungarian researchers.

 

Thanks. Yes, I've actually seen it, just didn't have the energy to read through it yet.

Yes, it is true, there isn't any kind of guidance or protocol and that is one of my arguments when I send letters about adapting the NICE guideline to people in key positions. The task here is not to change some deeply embedded BPS guideline but to even have one to begin with.

I don't have the energy to closely follow fibromyalgia and IBS but I'm quite sure they are in the same position, although they may be more talked about than ME/CFS.

Even by psychiatrists, ME/CFS is really just thought of as one of those many MUS things here and rarely gets discussed on its own. We are really mostly just forgotten and treated as random MUS, so it is quite different from the UK where BPSers have a special focus on it. You can see this from the Hungarian thread here on S4ME, where I post literally anything that gets posted about ME/CFS in Hungarian. Not much, and not even much BPS stuff, mostly just things adapted from English articles.

A couple of days ago there was a really long article on one of the major new sites about psychosomatic diseases (with BPSers talking about them) and how it is important to start a country-wide initiative in healthcare where people are sent with these problems and checked by BPS professionals instead of just getting lost in the healthcare system where doctors never find anything. Their definition seemed to be MUS, they emphasized that there is no organic cause here. And the people in the article focused very heavily on IBS and chronic pain. They even mentioned other diseases, that they can be themselves an organic problem but with a psychosomatic cause (and they talked a lot about emotional trauma etc as a cause). I remember they mentioned endometriosis and polycystic ovary syndrome as such examples.

But the interesting thing was that ME/CFS wasn't mentioned at all. If my memory serves my right, not even fatigue was mentioned specifically. And I'm not sure if this is due to the fact that they wanted to tread carefully because of the change how ME/CFS is viewed now by serious medical authorities abroad or simply because even BPS psychiatrists/psychologists couldn't care less here about ME/CFS and focus more on other diseases instead. Really, the latter is perfectly plausible, we are really not so much on the radar here. I mean of course if you ask them to talk about ME/CFS, they will say a lot of BPS stuff but it is not that they are going out of their way to do so.

Last year I posted about what they teach about ME/CFS at Semmelweis University (known as the No1 medical school here) in their family medicine course. The chapter tells doctors that these patients are convinced the symptoms have an organic cause and it is better not to argue with them about it, it is pointless. (I remember people with chronic Lyme were also specifically mentioned here.) You have to keep their trust, so without showing that you disagree, just gently lead them to the "right path", which is the BPS, PACE path of course. I remember thinking: OK, if a patient ever sees this, they will never trust a doctor again. Ever.

Yes, this, that you get no medication and all the other things of how little they understand about the impact on quality of life etc is what the patients experience too.

I just skimmed through the quotes from doctors in the study but to be honest some of those looked pretty appalling.