Healthcare professionals’ views on healthcare-related factors influencing symptom course in persistent somatic symptoms:... 2025 Kustra-Mulder et al

[Andy]

Full title: Healthcare professionals’ views on healthcare-related factors influencing symptom course in persistent somatic symptoms: a qualitative study of four European countries

Full author list:

• Aleksandra Kustra-Mulder,
• Brodie McGhie-Fraser,
• Tara Petzke,
• Karolina Fila-Pawłowska,
• Judith Rosmalen,
• Fiammetta Cosci,
• Bernd Löwe &
• Angelika Weigel

Abstract​

Background​

The care trajectory for patients with Persistent Somatic Symptoms (PSS) is complex due to variability in diagnoses and treatments, with differences across European healthcare systems. Existing findings predominantly come from individual Western European countries, and comparative studies are lacking. This study aimed to explore how healthcare systems are perceived to influence PSS courses across four European countries and how professionals view their respective systems regarding PSS.

Methods​

We used semi-structured interviews to conduct a qualitative study with healthcare professionals from Germany, Italy, the Netherlands, and Poland. Sixteen participants were recruited purposively through international and national networks focusing on PSS, ensuring representation from primary care, secondary care medical specialists, mental health, and other healthcare fields.

Results​

We found that the interaction of structural and interpersonal factors within the healthcare system influenced the course of PSS symptoms. Systemic barriers such as limited consultation times and issues in care pathways or insurance coverage were prevalent in Germany and the Netherlands, while access and trust issues were more prominent in Italy and Poland. Key improvements suggested included reimbursement and treatment eligibility for PSS, establishing collaborative care pathways, and sufficient consultation times. Additionally, enhancing professional-patient relationships and improving education for healthcare professionals and patients were identified as crucial steps.

Conclusions​

The results show that although expertise is improving, current healthcare system structures prevent professionals from using them effectively. Therefore, systemic reforms and better professional training are needed to improve care for patients with PSS.

Open access

 

[Andy]

"This study is part of ETUDE (Encompassing Training in Functional Disorders Across Europe; https://etude-itn.eu/), an innovative training network aiming to improve the understanding of the mechanisms, diagnosis, treatment, and stigmatization of PSS [19]. Healthcare professionals from Germany, Italy, the Netherlands, and Poland with experience in caring for patients with PSS were eligible to participate in a semi-structured interview. The included countries were chosen to represent Europe’s northern, southern, western, and eastern regions and the ETUDE network. The exclusion criteria were a lack of experience working with patients with PSS and insufficient verbal communication in German, Italian, Dutch, or Polish. The COREQ guideline was used for the reporting of this study [20]."

Thread on ETUDE, https://www.s4me.info/threads/etude...-in-functional-disorders-across-europe.16016/

 

[Utsikt]

How could this possibly add any value at all?

 

[rvallee]

The results show that although expertise is improving

Delusional. Or lies. Probably a combination of both.

They seem to be basing their notion of improvements in expertise based on how many patients they can churn through. And in an industry where improving things by 10% is huge, it takes very little to give the false impression of making things better, when things are actually getting significantly worse. So, literally, the worse things get, the better they feel they are doing. Amazing.

It's notable that the factors here have very little overlap with what patients report, and where overlap exists, it doesn't agree on the reasons why.

“There’s also this stereotype perpetuated that GPs somehow don’t have the competence and qualifications to treat psychosomatic symptoms or symptoms under the somatic form… patients don’t trust GPs in this area, especially those [patients] who have persistent somatic symptoms…, and therefore they turn to specialists, going through a long queue of consultations, often very lengthy.” (Psychiatrist, Poland).

GPs obviously have no such competence, but neither do specialists. So, again, either delusional, or lying to make it seem better.

“But then, uh, yeah, then you quickly get, uh, this back and forth, so to speak, with the patient coming back again, and then they see me again and say, “Well, I’ve been to a specialist, nothing came out of it, but I still have symptoms”, and then it starts. Actually, nothing has changed.” (GP, the Netherlands).

They can see the pieces of the puzzle, but they never put them together. Even when they are side-by-side.

“… Psychologists find pain quite complicated… there are hardly any psychologists who say, well, I want to deal with pain.” (Rehabilitation specialist, the Netherlands).

Obviously they should not be involved in this.

“Nowadays, patients are sometimes sent to me specifically because there are not so many specialized options for people with chronic complaints, they don’t get as much support in their practice, in the outpatient clinic outside, so to speak.” (Gynecologist, Germany).

Having specialist options is useless when they have no meaningful competence.

“The problem is always the usual one, i.e., it revolves around the fact that since there are no dedicated pathways the accessibility is poor and so… what often happens is that these patients um (reflecting) wander a bit aimlessly, if you can call it that, and so they don’t find their place [in terms of specialized care], they don’t come i.e./or the intake is done very late.” (Internist, Italy).

As it should. Why would such pathways exist when they are kabuki theater? There should not be any similar pathways for homeopathy either, for the same reasons.

“This link to or between somatic functional and psychiatric. So, I believe the psychiatric is again a whole different world in itself, and we are not yet so used to dealing with it in an interdisciplinary way. So, it is completely separated, psychiatric and somatic. And, uh, yes, that there is also no development in that area according to my perception.” (Gynecologist, Germany).

I don't know how the authors can include in the conclusions that things are improving when all the comments from physicians clearly state the opposite.

This is all frankly like asking a bunch of aristocrats how to deal with peasants being unhappy with being ruled by aristocrats. Aristocrats don't have to be personally cruel or corrupt for such a system to be dysfunctional and harmful. This is a system eating itself because it can't stop doing things it doesn't even know why it's doing, and should not even be doing in the first place, but it's how things have been when they got there so they can't think of doing things any other way than what clearly doesn't work, but has been asserted to be good in itself.

 

[Sean]

'We need to standardise our propaganda.'