Trust, belief and transitions: people’s experiences of multidisciplinary inpatient treatment for persistent physical symptoms 2024 Lewis et al

[Andy]

Abstract

Purpose
People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation.

Materials and Methods
18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis.

Results
Participants’ experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding.

Conclusions
Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients’ experiences of treatment.

Implications For Rehabilitation

• People with persistent physical symptoms view the building of trusting relationships with rehabilitation professionals as a vital component of specialist treatment
  
  
• Patients value the interpersonal style of the professional as much as the content of the intervention delivered.
  
  
• Developing an alliance and a shared understanding of symptoms takes time, high levels of tailoring, and a skilled multidisciplinary team
  
  
• Patients found abrupt discharge difficult, and desire easier access to appropriate follow up

Paywall, https://www.tandfonline.com/doi/full/10.1080/09638288.2024.2420833

 

[rvallee]

Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored.

Revelations like this as so illuminating. There is no reason for this model or those specialist centres as they are designed and why it should be recommended in the first place, it has no basis in fact. They know nothing of what happens to patients, the nature and substance of the treatments is basically a "no one actually cares what's in it" bunch of nonsense that is subject to zero oversight and requires no evidence.

But they see nothing wrong with that. They describe it as is and think that this is proper and adequate. They could write the exact same things about any other alternative medicine clinic and find everything wrong with it. But they do all the same things and it's great. Amazing.

And that's before you get to the bit about building trust when the entire purpose here is to lie and deceive people. Any other alternative medicine clinic would also find that their clients trusting them and having good rapport is crucial to the business. As would any cult or predatory MLM. But they see nothing wrong with that. It's not about what is done, it's about who is doing it. They would be wrong for doing the same things we do, which is right.

Patients value the interpersonal style of the professional as much as the content of the intervention delivered.

That's a really awkward way of acknowledging that the content is entirely irrelevant without actually acknowledging it. Again they see nothing wrong with sounding convincing being used as equivalent to delivering an effective service that actually affects outcomes. This is basically describing a con in all but name and confession.

 

[Joan Crawford]

"Patients value the interpersonal style of the professional as much as the content of the intervention delivered."

Blimey. That's quite an admission.

Nice to be talked too nicely and with something perceived as respect, or some such. Not treatment.

Achieving exactly nothing of substance or relevance to the real world to the patient, who just wants their life back, to go out to work, study, play with their kids and grandkids. Life stuff they often can barely do.

"People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease."

No mention of actually figuring out wot might be wrong. Zero ambition. Zero results.

Lots if talk of "treatment" but what are they actually treating and how is this being measured and assessed?

 

[Arnie Pye]

People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease.

In some cases the patient themselves may know the origin of some of their Persistent Physical Symptoms. But medical records are often so poorly written that doctors reading them later have no real idea of what exactly happened to the patient. And if the patient gives a different story to that told by the medical records the patient is always the one who is disbelieved.

 

[Maat]

"Patients value the interpersonal style of the professional as much as the content of the intervention delivered."

Blimey. That's quite an admission.

Nice to be talked too nicely and with something perceived as respect, or some such. Not treatment.

Achieving exactly nothing of substance or relevance to the real world to the patient, who just wants their life back, to go out to work, study, play with their kids and grandkids. Life stuff they often can barely do.

"People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease."

No mention of actually figuring out wot might be wrong. Zero ambition. Zero results.

Lots if talk of "treatment" but what are they actually treating and how is this being measured and assessed?

This.

and this:

implications For Rehabilitation

• 
  
  
  • People with persistent physical symptoms view the building of trusting relationships with rehabilitation professionals as a vital component of specialist treatment
  • Patients value the interpersonal style of the professional as much as the content of the intervention delivered.
  • Developing an alliance and a shared understanding of symptoms takes time, high levels of tailoring, and a skilled multidisciplinary team
  • Patients found abrupt discharge difficult, and desire easier access to appropriate follow up

Paywall, https://www.tandfonline.com/doi/full/10.1080/09638288.2024.2420833

"Shared understanding of symptoms"

translation you can control your symptoms by changing the way you think about them, and we'll explain how. (therapuetic exception to autonomy)

"Patients found abrupt discharge difficult, and desire easier access to appropriate follow up"

or any at all.

Entering a service diagnosed as mild/moderate and 6 weeks later being discharged back to GP as severe is a fairly abrupt transition. That's this bit of belt and braces approach to evidencing gathering for my potential clinical negligence claim wrapped up.

 

[Maat]

Implications For Rehabilitation

• People with persistent physical symptoms view the building of trusting relationships with rehabilitation professionals as a vital component of specialist treatment
  
  
• Patients value the interpersonal style of the professional as much as the content of the intervention delivered.
  
  
• Developing an alliance and a shared understanding of symptoms takes time, high levels of tailoring, and a skilled multidisciplinary team
  
  
• Patients found abrupt discharge difficult, and desire easier access to appropriate follow up

This thread should be read in tandem with this one Fatigue and sensorimotor instability Neurologically controlled conversion of post-COVID-19 patients, 2024, Urban et al | Science for ME

 

[Sean]

People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease.

'...not currently explained by..."

Which is a very different interpretation.

They are still stuck in we-just-need-to-tweak-the-marketing delusion.

 

[rvallee]

"Patients value the interpersonal style of the professional as much as the content of the intervention delivered."

Blimey. That's quite an admission.

Nice to be talked too nicely and with something perceived as respect, or some such. Not treatment.

It would be something to behold to simply replace a few terms and keep everything else the same, making this about some homeopathic clinic and how even the authors of this drivel would dismiss it out of hand. All the data could be the same, the conclusions, from reviewers and professional readers, would be a complete 180 shift.

It plays out the exact same dynamic as in politics: it is not what the person did but who they are. Friend of the regime? A prince? Committed some assault and a lot of fraud? Boys will be boys, or whatever. Some poor sod with the wrong combo of ethnicity or religion or whatever? Life in prison! Have to send a message that the law is the law! Exact same circumstances, the only difference is in the perception of who is judging and what they think of who did the thing, and that judgment can take a complete 180 based on nothing but a single arbitrary label.

 

[Trace]

It would be something to behold to simply replace a few terms and keep everything else the same, making this about some homeopathic clinic and how even the authors of this drivel would dismiss it out of hand. All the data could be the same, the conclusions, from reviewers and professional readers, would be a complete 180 shift.

It plays out the exact same dynamic as in politics: it is not what the person did but who they are. Friend of the regime? A prince? Committed some assault and a lot of fraud? Boys will be boys, or whatever. Some poor sod with the wrong combo of ethnicity or religion or whatever? Life in prison! Have to send a message that the law is the law! Exact same circumstances, the only difference is in the perception of who is judging and what they think of who did the thing, and that judgment can take a complete 180 based on nothing but a single arbitrary label.

Just out of curiosity, what's your experience of said treatment methods. Have you been in one of these places? Sorry just trying to understand what it is your trying to say. Other than its all a conspiracy?

 

[Jonathan Edwards]

Just out of curiosity, what's your experience of said treatment methods. Have you been in one of these places? Sorry just trying to understand what it is your trying to say. Other than its all a conspiracy?

I think the point people are making is that any particular person's experience of such places is irrelevant to whether or not the treatment actually helps. Papers like this tell us nothing useful about that - and yet they suggest that there are 'implications for rehabilitation'.

It is not so much a conspiracy as just dumb.

 

[rvallee]

Just out of curiosity, what's your experience of said treatment methods. Have you been in one of these places? Sorry just trying to understand what it is your trying to say. Other than its all a conspiracy?

It is not so much a conspiracy as just dumb.

I also don't think that other alternative medicine practitioners are in a conspiracy, they're also just wrong. Beliefs are weird like that, they can make even otherwise painfully critical people swallow total bunk.

Normally they use science to know better. Here instead they use evidence-based medicine, which is a very low standard, or at least parts of the paradigm have such extremely low standards they allow traditional beliefs to appear to be credible, as long as one believes in the thing.

And it just so happens that the magical powers of the mind over the body are one of the last great belief systems, popular enough to always be received favorably, if not simply out of curiosity. It's about on par with beliefs in ghosts and angels 500 years ago. No one ever mocks the idea, it's always at least a credible topic of discussion.

 

[bobbler]

Just out of curiosity, what's your experience of said treatment methods. Have you been in one of these places? Sorry just trying to understand what it is your trying to say. Other than its all a conspiracy?

Interesting point.

What's your experience and thoughts?

Have you ever been to a doctor or medical appointment with something serious, and what was your experience or expectation?

What / who do you assume this is covering? ie a lot of laypersons think these are people who have been checked that it isn't x, y, z and clearly don't have something serious or urgent - that there is some sort of diagnostic process before for this