Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis, 1996, Butler and Rollnick

Missing the meaning and provoking resistance; a case of myalgic encephalomyelitis
https://academic.oup.com/fampra/article/13/1/106/512679?login=false

By Chris Butler and Stephen Rollnick, published 1996

Abstract
Background
The interaction between a clinician and a patient who put his problems down to myalgic encephalomyelitis is described. Despite attempting a patient-centred approach, the doctor acted on his own understanding of the meaning of this diagnosis without gaining proper insight into what it meant for the patient. This failure not only led to damaged rapport, it may have contributed to delayed recovery.

Objectives
The unsatisfactory nature of this encounter led the clinician to consider more effective consulting techniques.

Methods and results
A hypothetical interaction is constructed in which the clinician uses reflective listening statements to understand the patient's true meaning of this self-diagnosis.

Conclusions
Despite well intentioned attempts to be patient-centred through widening the consultation beyond the biomedical to include personal and contextual factors, clinicians may still end up imposing their own medical meaning on patient's words. Damaged rapport is a signal that another tack could be more fruitful and reflective listening is one strategy which enables clinicians to check that they fully understand the patient's meaning. Provoking resistance by following strategies which are not appropriate for the patient might then be avoided.

The full-text is available, but I'll warn you that it's legitimately disturbing.

 

This is one of the most disturbing ME papers I've ever read. A 27 year-old man came into a doctor's office, very anxious, with a multitude of symptoms, including textbook PEM. He's convinced he has ME, and his symptoms are glaringly obvious--PEM and being severely debilitated, unable to work. But the doctor chooses to treat him without dignity, in part because he has co-occurring mental health issues, including heavy drinking and panic attacks. The doctor insists he has a fear of exerting himself and needs to go back to work. Eventually the doctor convinces him to attempt to return to work. On his first day back, he falls and breaks his tibia and fibula (the bones in your thigh, which are very strong and difficult to break). We don't know this guy, but he probably lost everything due to ME, and the authors dare to further strip him of his dignity by implying he wanted to fall in order to skip work.

I begin to wonder where he is now, wishing I could hear his perspective. Did he leave and find a sympathetic doctor? Did his life further fall apart as a result of this iatrogenic harm? Did he die, perhaps in part due to poverty from being denied benefits? Is he lurking on S4ME and reading this?

Edit: And if you're wondering how I dredged up an article from 1996, I was reading Clinical support and encouragement versus manipulation (includes motivational interviewing), and decided to Google motivational interviewing me/cfs.

 

Thanks for sharing. I had not seen that article before. Sad how even then how the behavioural avoidance clap trap was well embedded into the doctors mindset based on no evidence whatsoever other than someone told him so.

Rather ironic this was about a failure of listening and communication. And complete failure to understand the patients problems and symptoms. The patients 'error' if you can call it that was to appear anxious and overwhelmed. And to push back with the doctors view. As in stand up for themselves. I bet they bitterly regretted agreeing to return to work. Although I don't think they got much choice. Horrific and manipulative experience for the patient.

 

It certainly doesn't reflect well

 

Ditto:

Chris Butler: Professor of Primary Care

• lead the Infections and Acute Care Research Group
• Clinical Director of the University of Oxford Primary Care Clinical Trials Unit
• Deputy Clinical Director of the NIHR Community Healthcare MedTech and In-vitro Diagnostics Co-operative
• Professorial Fellow at Trinity College
• Fellow of the Academy of Medical Sciences
• Chair of the Longitude Prize Advisory Panel
• Honorary Professor in the Department of Medicine, Division of Infectious Diseases and HIV Medicine at University of Cape Town
• Part time Professor, Department of Family Medicine, McMaster University

Research

My research focuses on common infections (especially the appropriate use of antimicrobials, antimicrobial resistance, point of care testing, and treatments for viral infections), and health care communication and behaviour change (co-author of Motivational Interviewing in Health Care).

I am co-Chief Investigator of the PRINCIPLE and PANORAMIC adaptive, platform, randomised, controlled trials of community treatments for COVID 19, that have recruited >38,000 participants and evaluated 9 medicines so far.

I have published >500 papers and led or helped lead ~30 randomised clinical trials, and have recently published trial results in the world’s top three general medical journals. My H-Index is >60. Our PACE Study won the Royal College of General Practitioners Research Paper of the Year Award in 2020.

Supervision

I have supervised 18 doctoral students to successful completion and currently supervise 2 doctoral students.