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Lost in fragmentation — care coordination when somatic symptoms persist: a qualitative study of patients’ experiences, 2022, Barends et al

Discussion in 'Other psychosomatic news and research' started by Andy, Sep 21, 2022.

  1. Andy

    Andy Committee Member

    Hampshire, UK
    GPs can play a central role in the care of patients with persistent somatic symptoms (PSS). To date, little is known about these patients’ experiences relating to their coordination of care.

    To explore the experiences of patients with PSS relating to coordination of care — in particular by their GP — during their illness trajectory.

    Design and setting
    This qualitative study was carried out from January to April 2019 in the Netherlands as part of a multicentre prospective cohort study on the course of PSS (PROSPECTS).

    Thematic content analysis of 15 interviews.

    Three themes were identified: care fragmentation during the diagnostic trajectory; transition from the search for a cure to coping; and reframing to coping: GPs’ role in facilitating supportive care. Patients experienced a lack of collaboration from healthcare workers during the diagnostic trajectory. Guidance by their GP in a process of shared decision making was positively valued by patients. Moving the focus from searching for a cure to coping with symptoms was described as a ‘personal endeavour’, made even more challenging by the ongoing uncertainty experienced by patients. When reframing to coping, the extent to which patients felt aligned with their GP played an important role in whether their supportive care request was met.

    Patients experienced difficulties when navigating the diagnostic trajectory and shifting to coping. The findings of this study underline the importance of collaboration between GPs and other healthcare professionals during the diagnostic trajectory. The authors recommend that GPs provide proactive guidance and are sensitive to patients who shift to coping by providing them with supportive care in a process of shared decision making.

    Open access, https://bjgp.org/content/early/2022/09/19/BJGP.2021.0566
    Peter Trewhitt, oldtimer and Mithriel like this.
  2. rvallee

    rvallee Senior Member (Voting Rights)

    Their what now? Is it at the same place as all the free ponies and secondary benefits we all get?
    Out of what hat are they going to pull that? Basically: just wing it. Yeah, that'll do it. Wear the white coat, put on a solemn expression, hold their hands and declare "it's healing time!"

    Good grief just stop whining about how hard it is and just do the damn work (or ideally step aside and let competent people do it). At this point it's literally been more work to fabricate excuses than to do it in the first place. It's not as if decades of myth-building were ever going to amount to anything more than a collection of "we used to say that but now we still mean it we just don't say it out loud".
    Peter Trewhitt, J.G, oldtimer and 2 others like this.
  3. Art Vandelay

    Art Vandelay Senior Member (Voting Rights)

    Adelaide, Australia

    We spoke to a group of patients who had been told that their unexplained physical symptoms were created by their inappropriate thoughts and beliefs. They were told the cure was to "stop thinking incorrectly" and to "suck it up, buttercup".

    While lesser mortals with common sense may conclude that this explanation is wildly speculative and pseudoscientific, those of us in medicine strongly believe in it because it was contained in a psychiatry textbook on hysteria we were forced to memorise at medical school and it reinforces our smug feelings of superiority.

    Inexplicably, these patients were dissatisfied with the quality of healthcare they were receiving. We advise that their GPs speak to them in a more condescending and dismissive manner until they give up on monopolising scarce resources.
    Last edited: Sep 22, 2022

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