Improving GPs’ approaches to functional somatic syndromes: a pilot training program with a focus on compassion & communication, 2025, Ariane

Dolphin

Dolphin

Senior Member (Voting Rights)
https://link.springer.com/article/10.1186/s12909-024-06619-0

Improving general practitioners’ approaches to functional somatic syndromes: a pilot training program with a focus on compassion and communication
open access
BMC Medical Education
Click to expand...
Abstract
Background
Functional somatic syndromes are common in primary care and represent a challenge for general practitioners (GPs), with a risk of deterioration in the doctor-patient relationship, and of compassion fatigue on the part of the physician. Little is known about how to teach better management of these symptoms.

Methods
The aim of our scientific team was to develop a training session about functional somatic syndromes for GPs, with the objective to improve the therapeutic attitude of the participants. The first session of the training was constructed as a pilot session, followed by a qualitative study to complete content validation. The educational framework of the training session is multimodal and includes theory on the pathophysiology of functional somatic syndromes, communication skills, and introspective learning including an introduction to compassion meditation. 20 physicians attended the pilot training session. 10 of them participated in the qualitative study. The qualitative study consisted of five individual semi-structured interviews and one focus group of five persons, investigating the impact of the training session on the clinical practices, as perceived by the participants. The interviews were analysed through an inductive method inspired by Malterud’s systematic text condensation strategy.

Results
We identified three main themes in the responses of the participants: (1) the crucial issue of putting a name to chronic psychosomatic suffering; (2) the importance of self-compassion for physicians; (3) changes in therapeutic attitude fostering a reconciliation between “self” and “care”. Participants expressed a need for more regular meetings of this type. The opportunity to share their negative feelings about therapeutic relationship within a peer group, with compassionate supervision of the trainers, seemed to play an important role in the improvement of their self-compassion

Conclusion
A multimodal teaching session seems to help the physicians to feel more comfortable and competent when treating patients with functional somatic syndromes. Including compassion meditation in the teaching seems a promising tool to prevent compassion fatigue.
 
Last edited by a moderator:
Training program
We developed a training program divided in three sessions of two days each, building most of the teaching on theoretical interactive discussions and role plays grounded on real clinical cases brought in by participants. Each participant was asked to provide a clinical story in one of the following 6 categories: (1) chronic pain; (2) chronic fatigue syndrome or fibromyalgia; (3) functional digestive disorders; (4) functional neurological disorders; (5) health anxiety, and (6) chronic depression. Chronic depression is included in the teaching because it has an important correlation with chronic physical symptoms [29, 30]: the impact of chronic physical symptoms is worse in the presence of depression; and a depressed mood is frequently found in patients presenting with chronic unexplained symptoms. Moreover, in GPs’ representations, there is a great overlap between patients suffering from chronic depression and patients in complex psychosocial situations complaining of multiple somatic symptoms [29].
 
From the introduction:

As there is no scientific consensus to explain the pathophysiology of these symptoms, general practitioners (GPs) often have great difficulty answering patients when asked about the origin of their suffering [7], which can be noxious for the doctor-patient relationship [8]. Unlike other chronic diseases, where therapeutic failure can be attributed to the disease considered incurable, therapeutic failure in functional disorders is often experienced as a personal failure on the part of the physician, or ill will on the part of the patient.
Click to expand...

The first session is devoted to the specific question of diagnosis, as this is often the first problem clinicians face when trying to treat a functional somatic syndrome using their usual clinical thinking, which implies the need to determine a diagnosis for the symptoms before choosing a therapeutic strategy. Psychosomatic suffering is by definition very difficult to classify in diagnostic categories. This first session is comprised of theoretical overviews of the most recent scientific understanding of the physio/psychopathology of functional somatic syndromes, with the goal of restoring participants’ sense of medical competence.
Click to expand...

So they are training medical doctors to push non-consensus/non-evidence based explanations.

As well, participants acknowledged that agreeing with the patient on a medical name for their symptoms made it possible to move from the “search for a cause” phase to a “search for solutions” phase, and thus to mobilize the patient’s resources in the implementation of therapeutic approaches, including psychotherapy.
Click to expand...

How can you search for solutions if you have no understanding of the cause? It begs the question.


So we come to the crux of it:

During the interviews, many participants described favorable changes in their therapeutic posture, which helped them feel more comfortable, more competent, and less worried or exhausted when engaging in the care of patients with chronic psychosomatic conditions.
Click to expand...

The importance of self-compassion for physicians

While mindfulness has been extensively studied as a tool for improving doctor-patient relationship [43], compassion meditation is an emerging topic of interest for researchers and teachers in the field of empathy and compassion fatigue [44]. Compassion meditation (or loving-kindness meditation) is a mental training technique, which involves cultivating a benevolent intention towards others, whishing that others be relieved of their suffering. This technique is grounded in mindfulness meditation and also includes a practice of self-compassion, i.e. directing a benevolent intention towards oneself and realizing that our shameful imperfections and sense of failure are also shared by all other human beings (this concept being called common humanity or shared humanity) [45].
Our teaching program contains a short introduction to compassion meditation, including self-compassion. Despite some controversy about the exact delineation of this concept [46], self-compassion is increasingly recognized as a tool for helping caregivers facing difficult medical situations, improving their communication skills and empathy, and preventing compassion fatigue [45, 47]. In our study, we realized that a one-day initiation is not enough for physicians to develop a regular practice of compassion meditation, which requires a great deal of self-discipline and also the support of a practice group, with a sense of belonging to a community that shares common values. Moreover, this type of practice does not fit everybody. However, the collective experience of a common humanity shared in a peer group can already have a profound transformative power on physicians, helping them to free themselves of the guilt they may feel about their failure to cure patients in chronic psychosomatic suffering.
Two years after the training program, participants reported they greatly appreciated the attention given to their well-being as caregivers, which showed them a way to a more compassionate attitude towards themselves and helped them to develop new strategies to take better care of themselves. The components of self-compassion and shared humanity therefore seem to be the most operational in the teaching of compassionate meditation for participants. This ties in with the thinking developed by Sinclair and colleagues [46], who propose understanding the term self-compassion as “a composite of common facets of self-care, healthy self-attitude, and self-awareness […] which likely have a positive effect on the caregiving outcomes that impact healthcare providers and their patients, including compassion”.
Click to expand...

This training isn't about patient care at all, it's about making medical practitioners feel better about themselves.
 
Participants expressed a need for more regular meetings of this type. The opportunity to share their negative feelings about therapeutic relationship within a peer group, with compassionate supervision of the trainers, seemed to play an important role in the improvement of their self-compassion
Click to expand...

This first session is comprised of theoretical overviews of the most recent scientific understanding of the physio/psychopathology of functional somatic syndromes, with the goal of restoring participants’ sense of medical competence.
Click to expand...
:rofl: The poor lambs. It's so hard for these well-paid, well-respected doctors to feel incompetent in the face of 'a great difficulty answering patients when asked about the origin of their suffering'.

The answer? An agreement on an unevidenced story to tell, and some group meetings with other struggling doctors to regain their sense of superiority by talking about the difficult patients they have seen. And a nice bit of 'compassion meditation' to increase self-compassion.

This is not science! It should not be medicine! This paper is an account of storytelling to make privileged people who feel inadequate feel better at the expense of people who are facing much harder problems than 'not being omniscient'.

What is wrong with medical training that 'not having all the answers' is such a problem?
 
Last edited:
Once I was diagnosed some thirty years ago I recognised that I had a poorly understood condition with no evidenced treatment. I don’t think I have ever subsequently asked any of the GPs I have seen to explain ‘the origin of my suffering’, not even when I was in the ‘try any and every crackpot treatment’ stage.

Indeed I am sure I would regard any GP claiming to understand ME/CFS and/or offering any curative treatment with suspicion, and in all probability avoid them. All I expect from a GP is to try to establish if any new symptom is part of my ME or reflects a new potentially treatable condition, and to prescribe appropriate medication if needed to help manage my ME symptoms.
 
Last edited:
The paper said:
We identified three main themes in the responses of the participants: (1) the crucial issue of putting a name to chronic psychosomatic suffering; (2) the importance of self-compassion for physicians; (3) changes in therapeutic attitude fostering a reconciliation between “self” and “care”. Participants expressed a need for more regular meetings of this type. The opportunity to share their negative feelings about therapeutic relationship within a peer group, with compassionate supervision of the trainers, seemed to play an important role in the improvement of their self-compassion
Click to expand...
So they took it as a therapy session to make themselves feel better about failing at their job, by way of trying to convince themselves they aren't. Even managed to make the themes about themselves.
Conclusion said:
A multimodal teaching session seems to help the physicians to feel more comfortable and competent when treating patients with functional somatic syndromes. Including compassion meditation in the teaching seems a promising tool to prevent compassion fatigue.
Click to expand...
Pathetic. Completely jumped the shark.
 
How very convenient for the medical practitioners to have a garbage dump for somewhat hard to describe conditions, conditions that cause considerable suffering to the patients who have them, and NOT to the practitioners.

Since the science doesn't have the root causes nailed down, the practitioners, the all-knowing ones, chant with harmonic ecolalia from their recipe book of burned offerings.

Every generation of docs feels the need to sweep up into new classifications the same old and as yet unknown etiologies. As though a new dump signals some new knowledge.
 
isn't this just a newer version of the Gerada/Chalder gaslighting poison the well video?

Surely all of this is thinly veiled selling to doctors to make sure they think of these patients as deluded, the reason they are busy, undeserving of healthcare and to watch out for them and not check someone has something else first.

the 'deal with them' patients, and how to select them based on no evidence or investigation. I suspect the hidden gist of this is the sublayer of getting across the inference that the patient has no insight and that is why what they say doesn't add up with what is being done to them/chosen for them.

1. prime people to think there are lots of people with this, and they look like x, and its 'psychosomatic/functional'
2. prime people to think these people are 'hard to deal with' in order to justify priming mistreatment and disrespectful communication, and make people not feel guilty about the next bit - a bit of suggestion of 'don't engage' to prime even further without having to actual compromise yourself with a lie that they will act badly, just infer 'else you don't want to know what happens next'.
3. a lesson in how to ignore people, refuse to hear what they say and based on a decision within minutes of them entering a room (face doesn't fit) be primed to switch off, be disinterested and tell yourself it is their fault
4. start off with telling these people they should feel sorry for themselves, prioritise themselves - because after all these people aren't really their workload but thanks for being polite as you filter out the gatecrashers to the medical system
5. prime the cover up for your treatment not working by telling the doctors not that what you are about to tell them to deliver is a failure but that the patient will be dissatisfied because they are difficult people with a difficult attitude,
6. training in self-compassion/forgiving yourself - isn't your problem or fault. the thing is that this is all about diverting that blame to/moving away from compassion for the patient but not to those who invented dumping them into this category and who give those on the front line no option to investigate them properly or do anything else. Pretending they are the problem rather than the designers of the dystopia you are being made part of thrusting them into. It's difficult because you've been left with terrible offerings for this demographic of people because others have chosen them as not deserving so made up a narrative
 
I can understand that clinicians who by the nature of the job have to deal with people suffering and in distress every day sometimes themselves need support, and need to be aware of and take care of their own mental health. I can see that learning to practice self compassion might appeal to some as useful.

What I find unacceptable in this particular situation of dealing with people they categorise as having functional somatic syndromes is the idea that dealing with us requires a higher level of self care for the clinician.

Are we really such awful people that we damage the clinicians mental health? Or is it that they are conflicted because they know they are gaslighting us with their psychosomatic nonsense?

Maybe the clinicians among us could help us understand why their colleagues find us so traumatising.
 
Trish said:
I can understand that clinicians who by the nature of the job have to deal with people suffering and in distress every day sometimes themselves need support, and need to be aware of and take care of their own mental health. I can see that learning to practice self compassion might appeal to some as useful.

What I find unacceptable in this particular situation of dealing with people they categorise as having functional somatic syndromes is the idea that dealing with us requires a higher level of self care for the clinician.

Are we really such awful people that we damage the clinicians mental health? Or is it that they are conflicted because they know they are gaslighting us with their psychosomatic nonsense?

Maybe the clinicians among us could help us understand why their colleagues find us so traumatising.
Click to expand...
I personally think this is the bps trying to bridge that dissonance by replacing that nagging feeling due to the former (they are playing a part in something that shouldn’t be happening) with a programme suggesting it’s the latter so that everyone can rest easy with themselves that they feel better about people being treated badly because if they get worse it’s their attitude and ‘this type’ always end up hard to deal with because of them, but at least we did it as politely as we could.

I’ve watched people actually talk their way thru a reframing like this - sometimes with an outsider nudging in saying ‘see yes put yourself first, you aren’t less important than them’ (or something similar) - to a dilemma and then come to peace with something that horrifyingly to an outsider who can keep which way is north in watching the self-persuasion ends with them doing quite a visible big weight of shoulders ‘yes I’m ok with being like that now’ and that’s it they are then changed not just in their attitude to said others (giving no truck) but in what the truth now is.

It happens on more general level eg where they aren’t allowed the time to treat certain things properly but know it’s not right and so go ‘above and beyond’ then eventually get exhausted and either get persuaded, trained or worn down to drop their principles … but then forget about then and then rewrite the situation

that’s why the manifesto papers are so problematic we see the bps mostly focusing on

it’s about installing a new (belief system) truth and what is true and what is false via behaviour (putting people in impossible situations where the wrong thing is doable but the right thing isn’t) and then using sly propaganda and sophism through mind/thiught bending techniques to change peoples thinking ('see it from a different perspective/framing') from science - observation - to politics changing/priming what people actually see when said person from said demographic sits in front of them, so that science isn’t possible because the observation/what they have been pointed to 'notice' has been primed.

the thing is as we see from BACME those either attracted into/by or who are changed by it often, as with anything, tend to become the most evangelical and hard to deprogramme
 
Last edited:
NHS. 'Heartsink patients' GP Training schemes.

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://gp-training.hee.nhs.uk/bolt...52/2023/04/ST3-Heartsink-Patients-website.pdf


Heartsink patients include:

Dependent Clinger
Entitled Demander
Manipulative Help Rejecter
Self-destructive Denier
Somatisers
Organic Brian Disorders
Complex Physical Health Problems


'Somatisers:

* Physical symptoms as a manifestation of a primary psychological problem.
Don't confuse this with functional syndromes

* Focused on understanding nature of symptoms, and often request further investigations.

* Variable acceptance of psychology as cause of symptoms

* Usually evoke sense of frustration in clinicians'



At the end of listing all the terrible Heartsink patients 'types' (including patients with multiple physical disorders/diagnoses) the Drs are asked:

"How do you feel when you consult these types of patients?"

.
 
Last edited:
Lou B Lou said:
NHS. 'Heartsink patients' GP Training schemes.

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://gp-training.hee.nhs.uk/bolt...52/2023/04/ST3-Heartsink-Patients-website.pdf


Heartsink patients include:

Dependent Clinger
Entitled Demander
Manipulative Help Rejecter
Self-destructive Denier
Somatisers
Organic Brian Disorders
Complex Physical Health Problems


'Somatisers:

* Physical symptoms as a manifestation of a primary psychological problem.
Don't confuse this with functional syndromes

* Focused on understanding nature of symptoms, and often request further investigations.

* Variable acceptance of psychology as cause of symptoms

* Usually evoke sense of frustration in clinicians'



At the end of listing all the terrible Heartsink patients 'types' (including patients with multiple physical disorders/diagnoses) the Drs are asked:

"How do you feel when you consult these types of patients?"

.
Click to expand...

How much is all this medical hand wringing costing health care systems? How often do doctors miss simple solutions because they anguish over how difficult their patients are, rather than listen to them?

I am reminded of a friend who had not had an easy medical history, but who was experiencing severe pain whenever she bent forward following surgery. Endless advice on exercise and offers of counselling had no impact on the pain. It took over eighteen months for her to find a doctor willing to order a simple X-ray that identified the eleven inch stainless steel surgical instrument sitting in her chest cavity, and then several years of legal battles to get any form of apology.

How often are the precipitants of these ‘heart sink situation’ the result of break downs in communication, a failure to adequately express and adequately listen?
 
alktipping said:
More poisoning of the well intentional dumbing down of gatekeepers to reduce service costs within medical empires .
Click to expand...
Except without actually reducing service costs. Actually, this all increases not only the service costs themselves, but all overall costs and associated losses. Even though it's the primary goal. That's how bad at their job the people involved in this are. They literally make everyone pay more for worst outcomes and all for the privilege of ruining lives, for which they even have the shameless mediocrity to feel bad only for themselves, in a format that is basically bespoke to provide excuses for this evil system.

Just a pure concentrated form of mediocrity. If we're to follow Hanlon's razor and attribute this to stupidity/incompetence rather than malice, it's basically all the incompetence. All of it.
 
You must log in or register to reply here.
Back
Top Bottom