Understanding Veterans’ Causal Attributions of Physical Symptoms, 2020, Kimber et al

Andy

Andy

Retired committee member
Background
Illness beliefs are significant contributors to health outcomes. Beliefs about the cause of physical symptoms are considered particularly important among those with medically unexplained symptoms and illnesses (MUS); yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans). The goal of the current study was to examine Veteran's causal attributions of their physical symptoms.

Method
A total of 91 combat Veterans with MUS were surveyed using a mixed-methods design about the cause of their physical symptoms, physical symptom severity, and PTSD symptoms. Causal attributions of physical symptoms were analyzed through thematic response analysis and grouped into categories. Chi-square analysis was used to assess the distribution of causal attribution types across Veterans with varying physical symptom severity and PTSD symptom severity.

Results
Veterans with MUS reported an average of 7.9 physical symptoms, and attributed the cause of their symptoms to seven different categories (“Do not Know,” “Stress/Mental Health,” “Deployment/Environment,” “Functional/Symptom,” “Medically Explained,” “Medically Unexplained Syndrome,” and “Lifestyle”). Exploratory chi-square analysis revealed significant differences in causal attributions across physical symptom severity and severity of PTSD symptoms. Veterans with more severe PTSD and Veterans with more severe physical symptoms were more likely to attribute their MUS to stress/mental health or to a medically unexplained syndrome compared with those with low/no PTSD symptoms and physical symptom severity. Veterans with minimal PTSD and Veterans with minimal physical symptom severity were more likely to attribute the cause of their MUS to lifestyle choices (e.g., exercise/diet) compared with those with high PTSD and physical symptom severity.

Conclusion
Veterans with MUS endorse multiple, varied causal attributions for their physical symptoms, suggesting more complex causal beliefs than typically assumed. This has important implications for patient-provider communication and development of concordance around MUS treatment.
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Paywall, https://link.springer.com/article/10.1007/s12529-020-09918-0
Sci hub, https://sci-hub.tw/10.1007/s12529-020-09918-0
 
the big question for me is why do complete idiots believe that the present state of medical knowledge accounts for everything . also why would anyone believe that doctors can immediately and always give the correct diagnosis based on a very short interview with the patient . wilful ignorance among supposedly well educated people always makes me think of a fraudulent agenda .
 
the abstract said:
Background
Illness beliefs are significant contributors to health outcomes.
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Indeed they are, Kimber et al. The beliefs of you and your kind have seriously set back the research that might have given people with ME/CFS and other illnesses better health outcomes. The beliefs of you and your kind have resulted in people not seeking medical care for issues that can be treated, because of the disbelief and trauma they have experienced previously.

yet little is known about causal beliefs among those with the most severe MUS (i.e., Veterans).
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What? Veterans are the ones with the most severe MUS? Demonstrable nonsense in the first paragraph of an abstract is never a good look. Some veterans have very severe illnesses of the type that you would classify as MUS; some teenagers have very severe illnesses of the type that you would classify as MUS.

research suggests that the key to improving care of patients with MUS is to have patients and providers develop concordant beliefs about MUS. For example, Burton [3] and colleagues have suggested that functional explanations may be particularly helpful in building concordant beliefs between patients and providers. Functional explanations provide a mechanistic understanding of symptoms (e.g., overactive nerves). Improving our understanding of patients’ attributions of their symptoms is a necessary first step to clarify how patients and physicians can develop concordant beliefs surrounding MUS. This is particularly important for the Veteran population, where one-third report dissatisfaction with their healthcare and poor provider communication.
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This is just amazing. It's sounding as though, to these people, it is less important that the explanations for symptoms be true than that the patients and the doctors have the same explanation for symptoms.

the paper said:
MUS poses a prevalent and significant problem with an estimated 25–50% of patients seen by primary care providers presenting with MUS
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Oh, please.


BTW, the survey was sent to around 1000 veterans - they got 91 responses.
 
"""
Conclusion
Veterans with MUS endorse multiple, varied causal attributions for their physical symptoms, suggesting more complex causal beliefs than typically assumed. This has important implications for patient-provider communication and development of concordance around MUS treatment.
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There is a lack of concordance because doctors are transparently bullshitting people and/or blowing them off.

Physician credibility is the solution here. People are not nearly as stupid or crazy as these sorts of authors would wish to imply. The best way to deal with 90+% of people is to make sense and not be an asshole.

This abstract appears to have been written by weasels. Say what you mean.
 
Hutan said:
This is just amazing. It's sounding as though, to these people, it is less important that the explanations for symptoms be true than that the patients and the doctors have the same explanation for symptoms.
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Ah, well, you see, if the patient disagrees with the doctor he/she can be diagnosed as suffering Abnormal Illness Behaviour though even Pilowski admitted that it helped if the doctor was right.
 
Hutan said:
BTW, the survey was sent to around 1000 veterans - they got 91 responses.
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Thanks for pointing this out. How on earth is it allowed not the mention this in the abstract? This looks like a real mistake by peer review and the editors, it's misleading.

The paper reads:
Postal mail surveys were sent to ~ 1000 Veterans who had been referred for care to the tertiary clinics. There were 91 responses, which is a 9% response rate;
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Hutan said:
Indeed they are, Kimber et al. The beliefs of you and your kind have seriously set back the research that might have given people with ME/CFS and other illnesses better health outcomes. The beliefs of you and your kind have resulted in people not seeking medical care for issues that can be treated, because of the disbelief and trauma they have experienced previously.


What? Veterans are the ones with the most severe MUS? Demonstrable nonsense in the first paragraph of an abstract is never a good look. Some veterans have very severe illnesses of the type that you would classify as MUS; some teenagers have very severe illnesses of the type that you would classify as MUS.


This is just amazing. It's sounding as though, to these people, it is less important that the explanations for symptoms be true than that the patients and the doctors have the same explanation for symptoms.


Oh, please.


BTW, the survey was sent to around 1000 veterans - they got 91 responses.
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You raise excellent points.

From my clinical experience working in NHS chronic pain clinic for > 3 years if it were true that veterans were disproportionally affected by so-called MUS (which in their reasoning would include chronic pain / FMS) then I'd see this borne out in referrals and assessments to my NHS clinics. But we don't see this. I think out of everyone I've seen over the years we could count the number of military vets on one hand. And I've never had to refer to the veterans pain management program in London ever. I have all the details in my file - but never had to use it!

Makes me wonder....... how this got published!
 
alktipping said:
the big question for me is why do complete idiots believe that the present state of medical knowledge accounts for everything . also why would anyone believe that doctors can immediately and always give the correct diagnosis based on a very short interview with the patient . wilful ignorance among supposedly well educated people always makes me think of a fraudulent agenda
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There is another factor... Arrogance. Anyone who believes that they know everything there is to know about medicine and that they can know everything there is to know about a patient after a five minute appointment must be arrogant. And of course, the patient's medical records are written by other doctors the patient has seen who are assumed never to make mistakes too. And the records can still be used to dismiss a patient 50 years after they were written because they are, of course, never, ever wrong.
 
Arnie Pye said:
And the records can still be used to dismiss a patient 50 years after they were written because they are, of course, never, ever wrong.
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Unless, the doctor who wrote those previous medical records diagnosed ME/CFS; in which case future arrogant doctors are more than happy to dismiss previous doctor’s diagnosis entirely.

only happened with one GP, who I spent approximately 5 minutes with. He read my notes and ME diagnosis from 10 years earlier and said ‘I’ll be the judge of that!’ with a look of disdain.
 
Arnie Pye said:
There is another factor... Arrogance. Anyone who believes that they know everything there is to know about medicine and that they can know everything there is to know about a patient after a five minute appointment must be arrogant. And of course, the patient's medical records are written by other doctors the patient has seen who are assumed never to make mistakes too. And the records can still be used to dismiss a patient 50 years after they were written because they are, of course, never, ever wrong.
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I have supported patients (ME and others) whose medical records/notes have been inaccurate / misleading. Sometimes this can clearly be in error / misunderstanding and it can be simply corrected. However, when more speculative diagnoses are foisted on a person that makes no sense to the patients - personality disorder being but one example - it can have a stigmatising and shaming effect - or the patient can be just outraged and so forth. Ditto assumptions re ME and recovery/CBT/GET. Patients can feel disempowered and feel as though they cannot do anything - have no voice. However, I have pointed out that patients can write to correct inaccuracies and where they disagree with an opinion - especially if it was a character assassination. It's not something that springs to many peoples minds to do - and a well worded and correctly toned it can help patients to find a voice, fight back and preserve self esteem. And once a patient has found an assertive voice - they are way less likely to be taken for a ride in the future.

In my view sticking up for oneself (sometimes with a bit of help if that is needed) it to me demonstrates self respect, resilience and good mental health. Something I can point out in writing to GPs / consultants / social services etc too.

I occasionally cc a psychiatrist who has misdiagnosed a patients with bipolar / personality disorder with my assessment and / or final report after therapy which outlines clearly why this was not a positive thing and how it did not help the patients to understand themselves and their life experiences.

I have challenged old school pain consultants who speculate about patients 'personalities' and so forth when they don't recover from chronic pain in insurance/civil litigation cases. That is stepping way outside of their competencies. I have been chastised by a pain consultant who appeared horrified that I would leave a patient with chronic pain after our intervention. The patient had mild/mod levels of distress pre seeing me. We did some good work and she was then v low in distress/strain and managing her pain extremely well - but he chose not to agree with me, stating that if only I'd delve into her psyche I could cure her.......Honestly - pure Freudian tosh - and all done to try and reduce insurance pay-out/liability...... It's really rather easy to challenge as the consultants who behave like this (they are usually well known in the civil court circuit...) really don't seem to bother to find out what it is clinicians are doing in modern day pain management programmes and have no idea what the evidence base is! There is a strong hint in the title - pain management - not "Overcome your pain" :-) LOL So the end result is usually that the evidence trumps in UK courts. Good oh :-)
 
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