Understanding Patient–Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms 2022 Bellman and Zolnikov

Abstract
Introduction: Medically unexplained symptoms (MUS) is an umbrella term used for chronic and often disabling health symptoms and conditions that remain unexplained after standard medical examinations, testing, and/or appropriate workup. Patients with MUS tend to receive little to no treatment but remain distressed, stigmatized, and disabled by symptoms and iatrogenic factors.

Methods: A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS.

Results: The analysis of the interviews revealed that MUS could cause significant distress to patients, impairing their functioning and leading to permanent disability. Conventional healthcare cannot meet the medical needs of these patients and might be a potential source of harm to them. It should be noted that confirmation of conditions associated with clinically significant psychiatric premorbidity was not provided.

Conclusion: Inconsistent diagnostic criteria, lack of proper training and research, diagnostic overshadowing, and implicit bias in healthcare professionals can lead to negative patient outcomes and the overuse of alternative or non-evidence-based services. Guidance, practice-based improvement ideas, and suggestions specific to improving patient-provider relationships can be applied to generate positive health effects.

https://www.cureus.com/articles/126...nd-outcomes-in-medically-unexplained-symptoms

 

Cause. Effect. Failure fails. Always. Zero ability to assign proper blame despite decades of failure. Absurd lack of accountability.

Conventional healthcare has systematically refused to meet the medical needs of these patients and usually is a potential source of harm to them. Demedicalization of illness is not a neutral or natural process.

 

It sure can, look at all the CBT and GET that patients turn to.

 

This is mostly a quotes study, and the thematic is clear: no competent healthcare = bad outcomes. It could not be any more clear that the failure is with medicine. It's always the same, and yet the conclusion is always rejected, keeping the failure in a loop.

Good grief, even a snack bar could not operate this incompetently and cowardly:

The healthcare community has made it very clear that I have no value as a human.

Those people in medicine want an easy fix and there’s no easy fix for people like me and that frustrates them, and they take it out on us. It makes me feel even worse.

Every time I go to the doctor, I sit on the examination table and mentally prepare myself to be disbelieved. Some doctors expressed a “my-way-or-the-highway” approach to treating me, meaning I had to take whatever meds they said without question nor discussion. Otherwise, they would not treat me.

Doctors don’t know about this condition…or they believe that this condition is, like, ‘all in your head.​

I’ve had providers who say: ‘I don’t know what to do for you, It’s likely psychogenic.'

I will go out of my way to avoid seeking medical care. I have had episodes of tonsillitis completely unrelated to chemical injuries that I had let go untreated because I didn’t want to go (to the doctor’s office).

(The healthcare provider) began spraying (fragrant Lysol) around the entire waiting room while I was seated there, knowing I have asthma triggered by similar chemicals. (I asked them to stop, but) they refused to stop using Lysol and told me to go to my primary care provider to manage my ongoing care. I could not find another specialist in our area.

I was distraught (with) the first physician I tried to seek help from, who would not even come into the room…this person was unwilling to come face to face with me to even discuss the situation.
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Systemic problems are rarely this plainly spelled out and detailed. The Catholic church never had this much information about their own rape scandal, it's far more detailed and obvious, most of this has been public for decades.

It even kind of admits to the fact that one issue with modern medicine is that they don't treat people, they treat lab results and diagnostic codes, without which nothing is allowed to happen. Even though the lie is that they do otherwise.

This is a system failure. We did not design this system and do not run it. This is not our failure.

Actually, this is technically a right. Except it's actually a paper right, but it's supposed to be a right, not a cutesy thing.

Performative "empathy", when they mean sympathy here. No, performative sympathy is not a useful thing as it's been around for years and usually comes off as insulting as the performance part is not exactly theater-worthy.

Like all things, if you don't do the work, you don't produce results. Decades of refusing to do the work do not magically yield results. The failure is clear. The blame is clear. And yet, it keeps on failing and failing because of cowardice at blaming people who made awful decisions that ruined millions of lives.

And the genius solution, as always? Performative ritual:

The same failure as usual. They don't understand that the problem is the lack of a real explanation, not wanting any or a specific one. This is a scientific problem and they can't even think of it in these terms, which is why nothing good came out of this. They can't help to think of us like we're complete idiots who would be content with a piece of paper that says "congrats, you're disabled, now run along".

Literally a broken record:

Stuck on repeat. Industrial manufacturing has the concept of planned obsolescence, making products that don't last for long so people buy new ones regularly. Medicine genuinely has planned failure and they can't quit failing.

 

Agree with all above, just one thought about official and recorded MUS diagnoses - at least you can argue with an actual diagnosis that has been named and shared openly as opposed to secretly gossiped behind closed doors.

I had an informal, casually mentioned 'diagnosis' for another issue once, so I asked them to formally tell me the diagnosis, differentials, reasons for diagnosing, etc., so they actually had a thorough conversation with me and used a validated diagnostic questionnaire and retracted their 'diagnosis' which allowed me to continue seeking more *appropriate* help. Its not the end goal but perhaps a step towards the right direction, the end goal being no MUS diagnoses at all...

 

I would agree with this, but there is a go-around to performative empathy- It is to get all the patients together and bill them as group psychotherapy. The second go around is avoiding that and signing up the patients for group education where there will be a merry go round sessions of how to cope, how to breathe, how to sit, how to stand, how to sleep etc. Package it all up and call this health care. The draw back to this approach is that physicians do not have a longitudinal picture of patients- they see them once or twice and they are shoved to "education" with allied health professionals. This is not even fragmented health care. More like dislocated symptom management .