Unexplained vs explained symptoms: The difference is not in patients' language use. A quantitative analysis of linguistic markers, 2021, Stortenbeker

Highlights

• Patients with MUS are believed to have a deviant way of presenting symptoms.
• We systematically compared language use of patients with MUS and MES.
• Prejudices about communication of MUS patients cannot be detected in language use.
• Negative stereotyping and labelling may trigger communication problems.

Abstract

Objective
Patients with medically unexplained symptoms (MUS) are believed to have a deviant way of talking about complaints. This study systematically compared linguistic markers in symptom presentations of patients with MUS and medically explained symptoms (MES).

Methods
This content analysis (cross-sectional study) conceptualized relevant linguistic markers based on previous research about MUS communication. Linguistic markers included negations (“not”), intensifiers (“very”), diminishers (“a little”), first or third person subject (“I” vs. “my body”), subjectivity markers (“I think”) and abstraction (“I'm gasping for breath” vs. “I'm short of breath”). We also coded valence, reference to physical or mental states, and consultation phase. We compared 41 MUS and 41 MES transcribed video-recorded general practice consultations. Data were analyzed with binary random intercepts models.

Results
We selected and coded 2752 relevant utterances. Patients with MUS used less diminishers compared to patients with MES, but this main effect disappeared when consultation phase was included as predictor. For all other linguistic variables, the analyses did not reveal any variation in language use based on whether patients had MUS or MES. Importantly, utterances' valence and reference to physical or mental state did predict the use of linguistic markers.

Conclusion
We observed no systematic variations in linguistic markers for patients who suffered from MUS compared to MES. Patients varied their language use based on utterances' valence and reference to physical or mental states. Current ideas about deviant patient communication may be based on stigmatized perceptions of how patients with MUS communicate, rather than actual differences in their talk.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399921003123

 

Can anyone explain what valence means in normal English?

valence
noun [ C ]
us/ˈveɪ·ləns/
chemistry
the ability of an atom to combine with other atoms, measured by the number of electrons it will lose, add, or share

Describing communication from patients as "deviant" is an appalling use of language, in my opinion.

 

I guess they are using it in this sense

"Valence, or hedonic tone, is the affective quality referring to the intrinsic attractiveness/"good"-ness (positive valence) or averseness/"bad"-ness (negative valence) of an event, object, or situation.[1] The term also characterizes and categorizes specific emotions. For example, emotions popularly referred to as "negative", such as anger and fear, have negative valence. Joy has positive valence. Positively valenced emotions are evoked by positively valenced events, objects, or situations. The term is also used to describe the hedonic tone of feelings, affect, certain behaviors (for example, approach and avoidance), goal attainment or nonattainment, and conformity with or violation of norms. Ambivalence can be viewed as conflict between positive and negative valence-carriers.[citation needed]"

https://en.wikipedia.org/wiki/Valence_(psychology)

 

Interesting, isn't it, that a Centre for Language Studies would use language in such a way?

 

eeew! i wasnt aware of this, whats their evidence for it? although it wouldnt surprise me

indeed

One might say that given their supposed knowledge of such, that using the term reinforces the stigma they are highlighting... its almost as if they didnt like the results of the study... not accusing anyone, just sayin

 

I got the impression it was people who believed in MUS who felt it was one of the ways MUS sufferers showed they were not like ordinary patients.

Listening to people with MS talk about being diagnosed I was struck by the fact that so many of them agreed that they knew they had MS even before the doctor ran his tests. If we say we know we have ME without a doctors diagnosis that guess is seen as a sign of wanting the benefits of the sick role.

In the years I have mixed with people with MS I have continually found that they respond to illness just the way we do especially in things like trying all sorts of quack cures just in case they help and even some who retreat into the sick role and let someone else do everything for them which we rarely see in ME.

So many things that are seen as negative for us are just a normal response in any chronic disease yet they are all interpreted differently by medical professionals.

 

All these sort of prejudices come simply from the fact that doctors think patients with MUS do not really have an illness. Therefore, the way the patients presents themselves ("as if they really had an illness") is seen as highly problematic and totally out of place. It's a cognitive bias (halo effect but in reverse).

If someone with MS presented their symptoms to a doctor in an "unsual","deviant" or "emotional" manner, it wouldn't matter at all. Once the biological basis of an illness has been established nobody cares about these things anymore.

There are many incredibly successful people who speak in a weird manner but nobody is out there with pitchforks claiming they should be punished or stigmatized because they speak in a weird way. This goes for pretty much any quirk a person can possibly have, actually. If you are successful and bring value to the world there is a lot that you can get away with and people will simply gloss over. In many cases having all sorts of flaws will actually get people to like you more.

But if you are someone who is in a situation where other people perceive that you don't bring any value, they will dislike you and find all sorts of irrelevant stuff to blame for it. Even if you hypothetically had no flaws or quirks at all, people would still interpret your actions and behaviour in a way that makes you look bad.

A similar thing happens with doctors and MUS in my opinion.

 

Yes and it shatters a common myth seen in medical doctor based internet communities such as r/medicine.

 

Couldn't agree more!

 

I had the same response when I read the passage. Looking it up gave me:

Despite the origin, seems like a very loaded term in current use. Also whose accepted standards? Presumably the medical profession's.

ETA: "Deviate" though seems to carry none of the negative connotation.

 

I came to think that this may be a problem with people for whom English is not their first language.

Presumably they meant that usage differs from a norm, but even that is problematic for them. All they show is that it differs from that of the other group. How do they know about "normal" usage? If such a concept exists.

 

The passive verb avoids having to say who's doing the believing. Presumeably clinicians.

The English not First Language defence isn't good enough, if the authors are presuming to carry out a linguistic analysis, a competent understanding of the language they are analysing should be a given.

The authors could be using the word to mean "A thing, phenomenon, or trend that deviates from an expectation or pattern", but they should be sensitive to the common negative connotations of the word, especially in a paper which looks like it's trying to combat stigma. Bit of an own goal I'd say.

 

'Deviance' and 'valence' are just terms used in linguistics. I've had too little sleep and so can't attempt to explain them, but I wouldn't worry about them too much.

ETA: that odd-sounding term, 'utterances', is also common.

 

https://twitter.com/user/status/1461984021035077638


Twitter thread:

1) Apparently, there is a belief that patients with medically unexplained symptoms (MUS) have a deviant way of presenting symptoms.

The following study, however, compared language use of patients with MUS and medically explained symptoms (MES) and found no systematic differences.

2) The authors report:

“Our findings suggest that, despite prejudices about MUS symptom presentations being subjective, vague or exaggerated, linguistic markers of patients with MUS are not different from patients with MES”

3) In their conclusion they write:

“Current ideas about deviant patient communication may be based on stigmatized perceptions of how patients with MUS communicate, rather than actual differences in their talk”

4) Previous studies have indicated that doctors do change their language when patients suffer from MUS.

5) The authors write:

“Since GPs adjust their language and communication when patients suffer from MUS, they may unconsciously maintain or trigger communication problems during these challenging consultations”

6) The study is available here: https://www-sciencedirect-com.rsm.idm.oclc.org/science/article/pii/S0022399921003123

Discussion on the Science for ME forum here: https://www.s4me.info/threads/unexp...f-linguistic-markers-2021-stortenbeker.23359/

Caveat: I have no idea how reliable these linguistic analyses are.

 

I was struck by something from this table.

 

That is how I read it.

Basically seems to say that the only difference in communication between MUS patients and other patients is the way other people treat/speak to them. And that stigmatisation is the cause.

 

This is interesting, I recently posted an article about patient language use because I was thinking a lot about how I talk about my symptoms and how pwme or other stigmatised/misunderstood illnesses might communicate differently because they don't feel heard, or because some of the symptoms are just difficult to describe.

I definitely notice that my GP asks a different kind of collection of questions depending on what I'm talking about - general pain, headaches, sleep issues and it's questions about my behaviour, a lump on my foot and it's objective measures - how long, how fast has it grown, etc...but they don't want to know how long I've been getting worse tinnitus, how fast the headaches come on