Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study, 2019, Houwen et al

Andy

Andy

Retired committee member
Background
Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs’ difficulties in communication during MUS consultations.

Methods
We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication.

Results
Twenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs’ communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient’s story, the quality of the contact and sharing decisions). Analysis of the patients’ views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n = 42) the patients’ comments were positive. The video-recorded transcripts (n = 9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient).

Conclusion
GPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient).
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Open access, https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-019-1049-x
 
Did the 2 who found no MUS perhaps find something else?

Whilst many GPs could brush up communication skills , this should not focus at being able to label MUS via a semi structured BPS format for consultations.

How exactly were GPs advised re improvement
 
Hate to break it to you guys but the feng-shui of a burning house is entirely irrelevant to the outcome. This problem, of there being a huge number of health issues that remain to be solved, will not be fixed with small adjustments to behavior, anyone's behavior. This isn't just rearranging the chairs on the deck of Titanic, it's building an entire field of study around the most optimal way of rearranging those chairs while leaving the fate of the people entirely out of all considerations.

It's a systemic problem, the failure is throughout the entire system, at every step and every level, it affects every part of medicine, from clinical settings to education to research priorities and everything in between. It will not be fixed by small performative changes. Get a damn grip on reality.

All you're doing is perpetuating outcomes that everyone hates, largely because it's always been this way and because of the damn belief in magical psychology turtles-all-the-way-down explanations. Stop it. YOU ARE THE PROBLEM. I cannot stress it enough that the problem is YOU.
 
ballard said:
The best thing doctors who are having trouble communicating with their ME/CFS patients could do is to spend some time reading the latest research so they would actually have something to communicate.
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Agree. It appears that my GP is updated with ME info and continues to tell me, "well, they haven't figured it out yet" for the last 30 years.
 
I'm going to write this and then hide.

Yes, GPs are part of the problem. However, they are under significant time pressures and have ever increasing care pathways and referring limitations pressed on them. The system imposes rules and guidelines on them while the workload ensures very little time to lift their noses from the grindstone and smell the coffee.

I honestly think that the NICE guidelines have let them down too. When the day the truth of how ME (and possibly other) patients have been failed by NICE and the system, I reckon there are going to be some p****d off doctors out there.
 
Invisible Woman said:
I'm going to write this and then hide.

Yes, GPs are part of the problem. However, they are under significant time pressures and have ever increasing care pathways and referring limitations pressed on them. The system imposes rules and guidelines on them while the workload ensures very little time to lift their noses from the grindstone and smell the coffee.

I honestly think that the NICE guidelines have let them down too. When the day the truth of how ME (and possibly other) patients have been failed by NICE and the system, I reckon there are going to be some p****d off doctors out there.
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I think that BPS issues, while important to us, are not particularly central to most doctors. They are told certain things and believe them because people with expertise in that field should know what they are talking about whether it is FND or kidney failure.

Patients who worry about every little thing of there health or rush to the doctor when they see something on TV make up a disproportionate number of people they see. So it is easy for them to believe that some people have that so badly they become severely disabled by it especially since they do not see it often.

It is unfortunate for us that kind, caring or even disinterested doctors are told that the best way to treat these patients is CBT and GET for their own good and to save them from a life of suffering.

No one has the time or interest to investigate whether the experts are lying.
 
I also think one of the issues is that there seems to be an assumption that CBT or talking therapies can do no harm, even if they don't help.

If we are to believe talking therapies are effective for some then we need to acknowledge they could be harmful for others, especially when inappropriately provided.

We know PACE did a poor job tracking harm and, according to some participants, even actively avoided recording reports of harm. Many CFS clinics also operate on the assumption they can do no harm. Just because they failed to record evidence of harm, doesn't mean it hasn't happened.

Then there are the definitions of harm. Just like the definitions of recovery, both definitions should be meaningful to the patient.

I wonder if/how IAPT clinics record & report harm?
 
If you are having trouble providing drivelobabble ask in some drivelobabble consultants to research your problems and enhance your drivelobabble. It has to work. Thousands of satisfied customers say so. Everyone wants to be a drivelobabbler.

'I want to walk like you, talk like you ... ooooo.... ' what brilliant graphics those were.
 
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