Patients’ descriptions of relation between physical symptoms & negative emotions: a qualitative analysis of primary care consultations, 2019, Bekhuis

Andy

Andy

Retired committee member
Background Primary care guidelines for the management of persistent, often ‘medically unexplained’, physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions. However, many GPs experience difficulties in reaching a shared understanding with patients.

Aim To explore how patients with persistent symptoms describe their negative emotions in relation to their physical symptoms in primary care consultations, in order to help GPs recognise the patient’s starting points in such discussions.

Design and setting A qualitative analysis of 47 audiorecorded extended primary care consultations with 15 patients with persistent physical symptoms.

Method The types of relationships patients described between their physical symptoms and their negative emotions were categorised using content analysis. In a secondary analysis, the study explored whether patients made transitions between the types of relations they described through the course of the consultations.

Results All patients talked spontaneously about their negative emotions. Three main categories of relations between these emotions and physical symptoms were identified: separated (negation of a link between the two); connected (symptom and emotion are distinct entities that are connected); and inseparable (symptom and emotion are combined within a single entity). Some patients showed a transition between categories of relations during the intervention.

Conclusion Patients describe different types of relations between physical symptoms and negative emotions in consultations. Physical symptoms can be attributed to emotions when patients introduce this link themselves, but this link tends to be denied when introduced by the GP. Awareness of the ways patients discuss these relations could help GPs to better understand the patient’s view and, in this way, collaboratively move towards constructive explanations and symptom management strategies.
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Paywall, https://bjgp.org/content/early/2019/12/16/bjgp19X707369
Not available via Sci hub at time of posting

Post with link to open access here
 
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Trust is important in the doctor/patients relationship. So be open to what patients feel and ask them what's the link between their symptoms and their emotions.

(Of course, this trust relashionship stops instantly if patients say there's no link. Then, deny their reality and start to convert the deluded lost soul.)
 
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So why no comparison with the way people with diagnosed physical illnesses describe their emotions and the effect on symptoms, and perhaps another group prediagnosis, such as people with suspected MS who have not yet been diagnosed, so have the same sort of anxieties about their symptoms as someone with so called MUS.

Until we see the full paper it's hard to tell whether the authors' assumption is that MUS = psychosomatic, and MUS patients who attribute their symptoms to physical causes are deluded.

And how much is the GP leading the patient towards 'recognising' that their symptoms are psychosomatic instead of honestly telling them the cause is unknown. What games are they playing with patients? How much are patients just learning to play along with the GP in order to keep a good relationship with their doctor, or through belief that the doctor knows best.

It is possible that some temporary physical symptoms are triggered by psychological/social causes, for example tension headaches and insomnia caused by stress at work or in a relationship - I have suffered those myself, but they are completely different from ME. Surely that can be fairly easily worked out by doctor and patient together in an honest and open way.
 
strategist said:
By now the belief that emotions cause disease is part of popular culture so it's not surprising some patients might describe their illness in this way. More so when the cause is unknown.
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This is very true.

I have met cancer survivors who will talk about stress & negative emotions and the repression thereof, then getting sick and that forcing them to face up to those emotions and so recovering and now being in a much better place. No mention of the millions spent in research, specialist care, nursing support etc., etc.

Now, I'm not saying being confronted with a potentially fatal condition won't make you reassess your life, but that in itself is hardly curative.

I have also been bemused by other patients with ME or CFS diagnosis who seem to wholeheartedly embrace this type of thing. To declare that they are so badly traumatised by something that it has caused their debilitating physical symptoms. As everyone has experienced some negative emotion in life (it is a part of life) ergo their ill health has been caused by that emotion or negative experience too.

Ironically, they can make this sweeping assumption about other people, but if you question it then you are the one in denial and making a personal attack on them. Thus reinforcing their status as victim and their claim to the moral high ground.

Baffling.
 
So this and the difficulties for GP's in consultation paper have champions taking on board the problems for the BPS cabal in convincing the patient of their emotional illness. I can almost imagine them trolling through social media/forums looking for clues to how we think so as to best maneuver the patient to draw the correct conclusion about their illness.

It never stops being amazing how invested the pyschs are in their beliefs despite not any objective evidence.
Because psychology is their field they feel a need to make it relevant beyond what is reasonable. So here we are held hostage to servicing their needs. In turn IMO they prey on the desire of some patients to believe they can exert some kind of control over the illness toward being well. As mentioned above this is well exploited.

Ironically psychology could very well do a service here by helping clarify the language of and understanding of emotional states that arise from being ill. But it seems the psych's need their emotional dogma to be primary.

I hope reason prevails eventually.
 
And are those descriptions any different than "medically explained symptoms"? Even more relevant as Trish mentioned, comparisons with people who temporarily had "medically unexplained symptoms" that were later "explained" by people finally doing their damn job.

Of course they wouldn't be different, do they expect people suffering from the flu to break out in dance and song? So what's the point? Besides tone policing as a replacement to listening to the actual substance of what the words mean.

Weirdly enough, people calling their insurer after their house has burned down have negative emotions. Might want to check how those cause fire, I guess?

Less tripe, more reason in 2020, please and thank you.
 
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strategist said:
By now the belief that emotions cause disease is part of popular culture so it's not surprising some patients might describe their illness in this way. More so when the cause is unknown.
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A friend of mine recently told me about his own experiences, he actually had gotten a surgery (I indeed remembered it then). He told me that his associated pain only would have gone after the situation he had trouble with had resolved.

The main problem in general - and in ME/CFS in special - is, I think, that the possibilities of influences are not evaluated properly. How much of an influence in which situation is possible on a regular basis, e.g. when healing from treated cancer.

After all there is a good chance for ME/CFS though: Under the assumption that there is a mechanism of psychosomatic influence, this mechanism could be affected in ME. This at least could go for an explanation of the absolute misery reported by patients.
 
Trish said:
And how much is the GP leading the patient towards 'recognising' that their symptoms are psychosomatic instead of honestly telling them the cause is unknown. What games are they playing with patients? How much are patients just learning to play along with the GP in order to keep a good relationship with their doctor, or through belief that the doctor knows best.
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This.

When the discussion becomes how to sell the explanation and cure, chances are the medicos got nothing and simply cannot admit it.
 
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