Louise Stone1. 1. Centre for Values, Ethics and the Law in Medicine, University of Sydney, New South Wales, Australia. louise.stone@gpet.com.au
Abstract
BACKGROUND: Diagnosis brings order, predictability and validation to suffering. Patients with medically unexplained symptoms experience vulnerability and cultural invalidation. Doctors also struggle to manage these patients. OBJECTIVE: To explore the strategies general practitioners use to manage patients with mixed emotional and physical symptoms and no diagnosis. METHODS: Thematic analysis utilising semi-structured interviews of 24 Australian GPs. RESULTS: Validation of the patient as a person involved building a helpful therapeutic alliance. Commitment to the patient, which the GPs described as 'ownership', involved advocacy and support. Holding uncertainty involved managing the need for a disease name. This included harm minimisation, including uncertainty management. Shift to coping involved the challenges of managing ongoing symptoms that had no name, no cure and no predictable outcome. DISCUSSION: Managing patients with medically unexplained symptoms involves professional and personal challenges. However, many of the GPs in this study found managing these patients rewarding in the long term.
BACKGROUND: Diagnosis brings order, predictability and validation to suffering. Patients with medically unexplained symptoms experience vulnerability and cultural invalidation. Doctors also struggle to manage these patients. OBJECTIVE: To explore the strategies general practitioners use to manage patients with mixed emotional and physical symptoms and no diagnosis. METHODS: Thematic analysis utilising semi-structured interviews of 24 Australian GPs. RESULTS: Validation of the patient as a person involved building a helpful therapeutic alliance. Commitment to the patient, which the GPs described as 'ownership', involved advocacy and support. Holding uncertainty involved managing the need for a disease name. This included harm minimisation, including uncertainty management. Shift to coping involved the challenges of managing ongoing symptoms that had no name, no cure and no predictable outcome. DISCUSSION: Managing patients with medically unexplained symptoms involves professional and personal challenges. However, many of the GPs in this study found managing these patients rewarding in the long term.
Authors: Hieke Barends; Femke Botman; Ella Walstock; Nikki Claassen-van Dessel; Johannes C van der Wouden; Tim Olde Hartman; Joost Dekker; Henriëtte E van der Horst Journal: Br J Gen Pract Date: 2022-06-20 Impact factor: 6.302