Clinical physiologists’ experiences of working with people with nonepileptic attack disorder: A qualitative study, 2022, McNicholas and Pryce

Highlights

• Participants describe working with people with nonepileptic attack disorder as stressful.
• The source of stress related to confusion over professional role and tension between diagnostic responsibilities and caring.
• Participants were unprepared in their training to manage emotionally laden conversations with patients.
• This risks patients’ needs not being met during clinical encounters.

Abstract

Objectives
To explore the perspectives of clinical physiologists on working with patients with nonepileptic attack disorder (NEAD).
Nonepileptic attack disorder is a medically unexplained symptom frequently encountered by clinical physiologists in the field of neurophysiology. Studies in healthcare professionals show that they often find patients with medically unexplained symptoms challenging, uncomfortable, and frustrating to interact with. Clinical physiologists spend a substantial amount of time with patients and are key to the assessment of the condition. It is not known how physiologists experience working with patients with NEAD.

Methods
Semi-structured interviews were conducted with clinical physiologists who frequently work with these patients. Interviews were recorded, transcribed, and analyzed according to grounded theory methodology.

Results
Twelve participants including current trainees and qualified clinical physiologists working in neurophysiology were interviewed for the study.
Participants described the experience of working with people with NEAD as anxiety provoking and unpredictable. The sources of this anxiety were the nature of the psychological aspects of the condition, the need to preserve professional boundaries and a lack of preparedness to manage conversations about distress or the psychological factors impacting the NEAD.

Conclusions
There is a risk that patient care is compromised by the lack of preparation and skills training of physiologists.

Practice Implications
Physiologists need further training in counseling skills to increase tolerance to emotionally laden content in patient accounts and knowledge of suitable referral routes.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(21)00762-9/fulltext

 

Have they tried CBT? Why do they never use their own advice? Oh, that's right, it's BS and they know it deep down. Seriously though, how would they feel about CBT to solve this, and nothing else? Let's see how they like it. They say anxiety is the problem and CBT is the solution to anxiety. How could this not "work"? This is the ideal scenario that CBT promises.

Also it really sounds like anxiety is mostly code for "I don't like this situation", but let's arbitrarily psychopathologize everything anyway.

And if they're struggling to deal with emotionally-laden discussions when it doesn't even apply, how do they handle actual emotionally-laden discussions? You know, most of their job. What they're actually struggling with is their own failure, and they still blame the patients for being difficult. That doesn't look like self-efficacy to me, and lots of psychological projection to boot.