Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms, 2023, Fryer et al

Andy

Andy

Retired committee member
Other authors include Vincent Deary and Christopher Burton.

Highlights
  • Medical consultations for persistent (“medically unexplained”) physical symptoms present particular challenges

  • Symptoms can be explained as central and peripheral processes; however these explanations are rarely used in consultations.

  • We developed an extended medical consultation model, which emphasises Recognition, Explanation, Action and Learning.

  • This paper describes the model, its teaching and delivery within a multicentre randomised controlled trial.

Abstract

Objective
To describe the teaching and delivery of an extended consultation model designed for clinicians to use with patients with persistent physical symptoms and functional disorders. The model is underpinned by current scientific knowledge about persistent physical symptoms and the communication problems that arise in dealing with them.

Methods
Process evaluation of training and delivery of the Recognition, Explanation, Action, Learning (REAL) model within the Multiple Symptoms Study 3: a randomised controlled trial of an extended-role GP “Symptoms Clinic”. Evaluation used clinician and patient interviews and consultation transcripts.

Results
7 GPs were trained in the intervention and 6 of them went on to deliver the REAL model in Symptoms Clinics either face-to-face or online. The Symptoms Clinic provided a set of 4 extended consultations to approximately 170 patients. Evaluation of training indicated that there was a considerable load in terms of new knowledge and skills. Evaluation of delivery found clinicians could adapt the model to individual patients while maintaining a high level of fidelity to its core components.

Conclusion
REAL is a teachable consultation model addressing specific clinical communication issues for people with persistent physical symptoms.

Practice Implications
REAL enables clinicians to explain persistent physical symptoms in a beneficial way.

Open access, https://www.sciencedirect.com/science/article/pii/S0738399123002501
 
Quote from the section on training days for GP's

Symptoms Science An integrated model of symptom perception: brain-body signalling and symptom perception
Multiple causal factors: comorbid diseases; genetic / epigenetic; early life adversity; neural plasticity; interoception; autonomic; immune; psychological
Mechanisms of symptom generation or persistence: somatic; central sensitisation; energy conservation; dissociation; threat-alarm; attention & amplification.

Action to manage symptoms Symptom management techniques: teaching and discussion of simple symptom control techniques including relaxation, breath control techniques and sensory grounding.
___________

This reminds me horribly of LP. Make up a scientific sounding explaination and then use techniques to get patients to ignore their symptoms.
 
Trish said:
Quote from the section on training days for GP's

Symptoms Science An integrated model of symptom perception: brain-body signalling and symptom perception
Multiple causal factors: comorbid diseases; genetic / epigenetic; early life adversity; neural plasticity; interoception; autonomic; immune; psychological
Mechanisms of symptom generation or persistence: somatic; central sensitisation; energy conservation; dissociation; threat-alarm; attention & amplification.

Action to manage symptoms Symptom management techniques: teaching and discussion of simple symptom control techniques including relaxation, breath control techniques and sensory grounding.
___________

This reminds me horribly of LP. Make up a scientific sounding explaination and then use techniques to get patients to ignore their symptoms.
Click to expand...

It's everything in the kitchen sink. Lob it all in. Mix it all about. Regurgitate it with some formal, biggy, serious sounding words and BINGO ta da It's a fact worth teaching to professionals.

:banghead:

It is simply makey, uppy itis. The antithesis of science.
 
Kate Fryer and Christopher Burton
Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
Tom Sanders
Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK

Monica Greco
Department of Sociology, Goldsmiths, University of London, London, UK

Cara Mooney
School for Health & Related Research, University of Sheffield, Sheffield, UK
Vincent Deary
Department of Psychology, Northumbria University, Newcastle upon Tyne, UK


So we have sociology, psychology and social work being brought in on dealing with people with physical symptoms. Surely a clear sign the people running the training don't believe the symptoms have any physical basis, apart possibly stress influencing stress hormones.

And GP's are being expected to take on board the latest fashion in unevidenced 'treatment' which seems to be to

- pat the patients on the head (metaphorically) and tell them you believe their symptoms are real,

- bamboozle patients into thinking they are being given a scientific explanation,

- then tell them to go away and ignore their symptoms and do a bit of meditation. In other words, stop bothering your GP, if the meditation doesn't work, tough.
 
Energy conservation…. attention & amplification

so as soon as you say I have to try to manage my energy carefully, I have to monitor my symptoms you are pressing alarm buttons traps to those who have been through this “training” and have had their thinking adjusted away from believing you
 
Another "new" copy-paste of the same old. Always the same recycled crap. And they get paid for this. Again and again. I was a programmer for over a decade and did not copy-paste as much of my work as these people did.

In their own literature it's well-documented that patients don't buy their BS. They can easily find out by simply reading or hearing from the patients. And all they do is copy-paste again and again the same old BS with small tweaks that are recycled endlessly. This is nihilistic pseudomedicine, doesn't give a damn about what's valid, and even less about patients, is antiscience and could not be tailor-made to harm people if it tried.

I'm genuinely not sure if the average politician is as much cynical and indifferent than these people. The context created by modern medicine is poisonous, makes smart people who think they're doing good do as much harm as the worst corporate raiders out there. Even MBA consultants put more effort into making sense than this, and they are famous for putting out empty word salads.
 
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