How to learn skilled communication in primary care MUS consultations: a focus group study, Houwen et al, 2021

Abstract only at Pubmed, https://pubmed.ncbi.nlm.nih.gov/33569982/
No other link working at time of posting.

 

My first thought is their need to teach GPs how to bullshit, bluster and gaslight their patients, who are unimpressed by being 'diagnosed' with something devoid of a diagnosis. I would like to think a majority of GPs find this unethical and alien to their calling, and might be why they are not equipped with such skills.

 

That is sheer lunacy. Either they have the communication skills to do their job or they don't.

While probably a fair percentage of what a GP sees might well be instantly recognisable & diagnosed on the spot, lots of chronic health problems that have biomarkers or recognized signs take a long time to diagnose. Those with more complex health problems will also need good communication with the GP.

Then there are all the people who can't or won't comply with treatment that a GP has to manage.

If they need specific training in communication with a specific group of patients, whose first language is the same as their own, there is a big problem somewhere. I think we know where.

 

Excellent point - let me see now....who might our community know that this applies to hhmmm...

 

I doubt that there will be a rush of GPs keen to pursue this training.

 

All about style of communication, not substance. Because there is no substance, so only style. This is basically sales training. Seriously this is the kind of stuff they actually teach to salespeople. I even noticed some papers advising the more superficial stuff like smiling a lot and having a neat office. This is sales training, not communication.

Also communication without integrity is basically lying. Don't lie to sick people, especially not as a medical professional. I have utmost contempt for people who do that, especially because they only do that because they can get away with it.

And important point: medical doctors absolutely suck at communication, to an offensive level. Right there with the most socially awkward engineers. Some are good, most are terrible, it's an individual thing, training seems to have no impact on it. This isn't something that can be tweaked, and empathy is not some performative thing. It wasn't necessary to invent the euphemism of "bedside manners" for nothing, physicians are notorious as having the communication skills and empathy of a rock. The only explanation is that medical training reinforces this.

This has decaying empire stink to it. Medicine is genuinely regressing, not by years, decades. Largely because it is completely unaccountable and nothing pierces the echo chamber. It's maddening.

 

Great points. Would you consider a letter to the editor?

 

Thank you.

I'm not really up to coherent letters at the minute as I've got a complicated situation going on at home that involves a lot of toing and froing with emails. My head is wrecked.

I'd be afraid they might want to enter into a dialogue & I can't guarantee I'd be able.for that.

If anyone feels up to a letter & wants to use any or all of the points I made then they have my full permission to use them.

 

hmmmn someone should explain to the authors that mus is only a placeholder until a medical profession with the right knowledge actually gives the correct diagnosis ,and in our present state of actual knowledge in how the extraordinarily complex chemical make up of the human body is not complete there will always be people put in the mus category . above all else doctors mis diagnosis rates are still at 36% a huge failure on the so called medical university courses meant to educate aspiring medical practitioners . iff i ever come across a gp who spouts this baseless crap at me i will walk out since i frequently do not have the energy or patience to deal with fools .

 

I speak from experience about the latter

Nobody took the communication classes seriously in my computer science program. Turns out it's super important. Still, nobody takes it seriously, everyone assumes they communicate just fine because they know words and communication is just using words (it isn't but whatever).

One of the ways this manifests is to adopt dense technical language and hundred-dollar words as a substitute for clear communication. Which accomplishes the opposite. It took me a long time to get it. STEMs without liberal arts train people very poorly. Medicine clearly suffers from the same.

 

The first time a doctor explained the BPS model of ME/CFS to me (he did so as if he was explaining something to a child), I burst out laughing.

At the time, I was so dizzy that I struggling to hold myself upright in the chair, I was drenched in sweat, my lymph nodes were on fire and this pretentious, condescending prat was telling me that my debilitating symptoms were imaginary and that I could banish them with a few sessions of therapy. I couldn't believe the Kafka-esque nightmare I'd found myself in and the laughter was an involuntary response.

The doctor's face turned bright purple with rage. When I stopped laughing, he lamely mumbled "well, it's good with pain too" to which I replied "I'd hate to be your patient if I had a broken leg".

Exactly.

I just can't understand why supposedly intelligent people believe this nonsense. It's staggering.

 

Couldn't agree more.

Still don't understand why they can't just call it the IDK (I don't know) instead of MUS (making up sh**). At least that way it would be reinforcing that this is yet to be understood and therefore an open mind might be required plus maybe some protection from snake oil sales rather than delving into lala land non treatments.

 

Also, a thought on labels.

We know there is a long list of chronic health conditions that take a long time and various tests, sometimes several repeats of the same tests, before diagnosis.

We know that the longer diagnosis is delayed in some of these conditions the more harm is done and that harm = suffering. To take the BPS view as it was intended, that suffering might also be to relationships and to employment and finances.

We also know that there's lots we don't know. Making assumptions can easily lead us very far astray unless we constantly look for and test the validity of those assumptions and be aware we could be wrong. The consequences of being wrong could cause a lot of unnecessary suffering in all.aspects of the patients life.

Labels are an issue. When I first became ill there was an argument that patients simply wanted a label that gave them an excuse to continue avoiding something they didn't want to do. This argument has come up in the long covid field recently - avoidance of work, sex with one's partner, taking out the bins or whatever.

If a label was seen as inappropriate (despite employers and the DWP demanding one) as it gave the person's false illness beliefs validity then surely labelling everyone with as yet unexplained or undiagnosed illness as MUS with the inherent assumptions associated with MUS, MUPS, BDS etc, is just as problematic.

Yet another inconsistency courtesy of our BPS pals. A patient who is ill and seeks to find out what is wrong so they can go back to life as usual is seeking validation and shouldn't be given that valid by way of a label. Yet applying a label that will stop, or cause significant delays, in diagnosis and treatment of patients and thus undue suffering is fine because it validates the false illness beliefs of the BPSers & creates job for them is okay.

 

I hope I can start laughing instead of crying next time. Somehow this thought made encounters with medical professionals seem a lot less scary.

 

Brilliant response under very difficult circumstances.

I am quite cynical that many BPS psycho babblers actually explain the BPS 'model' as it's such a shaky bonkers load of twaddle that is completely disconnected from patients experiencing and reality

I wonder if anybody apart from Vincent Deary has ever explained the 'autopoetic' MUS model to a patient. Imagine explaining that muppetry