Stigmatisation in clinical consultations for persistent physical symptoms/functional disorders: A best fit framework synthesis, 2024, Treufeldt et al

Highlights

• In consultations for PPS/FDs, stigmatisation can occur in various ways in the communication process.
  
  
• Current models do not accurately reflect the patients’ experiences of stigmatisation in their consultations for PPS/FDs.
  
  
• New way to understand and categorise common forms of stigma that patients come to contact in consultations for PPS/FDs.
  

Abstract

Introduction
Stigma is a social attribute that links a person to an undesirable characteristic and leads to actions that increase the social distance from that person. This includes different or discriminatory treatment. Stigma is common in healthcare, particularly in people with persistent physical symptoms (PPS) and functional disorders (FD). The aim of this study is to create a new actionable framework to aid understanding of stigmatisation in consultations about PPS/FD and to improve the consultation experiences.

Methods
This framework development used the Best Fit Framework approach to data collected for a scoping review of stigma in functional disorders. The stages included selection of an initial framework from existing conceptual models, mapping quote data from published papers to the framework and an iterative process of revision and re-mapping. The final framework was tested by re-mapping all the quote data to the framework following classification rules.

Results
253 quotes were obtained from the results sections of qualitative studies from a previous scoping review. The framework comprises of prejudice, stereotypes and actions to increase social distance. Stereotype refers to the focus of stigma: this may be the condition, the patient, or their behaviour. Actions that increase social distance include: othering; denial; non-explanation; minimising, norm-breaking; and psychologising.

By breaking down stigma into recognisable components, the framework provides a way to understand the difficulties that patients and clinicians face during consultations and a way to develop intervention materials.

Conclusions
This new framework for stigma in clinical consultations for PPS/FDs provides a useful tool for the study of stigma in clinical consultations.

Open access, https://www.sciencedirect.com/science/article/pii/S002239992400240X

 

See also
Stigmatisation in medical encounters for persistent physical symptoms/functional disorders: scoping review and thematic synthesis, 2024, Treufeldt
Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review... 2023 McGhie-Fraser et al

 

Could just stop right there. This describes the entire psychosomatic ideology, and the main reason why patients object in the first place. It's the same reaction we would have if we were told that it's an astrological or spiritual problem. Or podiatric, or chiropractic, or whatever. They simply don't listen to the words at all.

Literally what the entire thing is about, what patients have always objected to. This has been known for decades, and they think they can just invent yet another BS layer of obfuscation, which seems to be the only thing they can even think about.

This all the feel of people trying to address slavery by simply renaming it and using different language around it while keeping everything else the same. Completely ridiculous. An average teenager working a summer job takes their job more seriously than this.

The quotes are very damning. They explicitly point to the problem: them. And absolutely nothing will be learned by anyone involved in this.

Also, what decade is this even? About painful sexual intercourse:

Honestly, your average 10th generation aristocrat is more self-aware of the issues with tensions between aristocracy and the population than these people will ever be about the problems with their harmful gaslighting (not mentioned) ideology.

 

Indeed. There is a major issue here. Interesting that 'it can't be seen'.

And, whilst there are various questions these days about the Zimbardo prison experiment, that and other experiments that example what happens only with power distortion one could say are at a minimum firmly believed because nearly everyone has witnessed these effects close up.

When you begin to add in the incitement / license given in the case of functional 'accusations' I think that we need to start beginning to get across that the issue is nothing to do with the recipient of the abuse. The thing that is most horrific about it all is the rumour-mongering that tells laypersons 'hands off' by insinuating those who even might end up reported on in a news article 'must be different/mad/something else justifying it' that makes them stand out from firstly 'other pwme' and secondly 'normal people'.

Worse the freedom to make stuff up about someone means a freedom from culpability whatever happens.

Normally that difference if someone educated themselves is merely situational, because it seems they are left in a situation that breaches the Nice guidelines making them so ill they can't speak and then 'assessed' whilst still 'in it'. That's a major issue. It might be deemed acceptable (though I also think that's a major human rights issue) to wind up someone with other mental health issues and then assess them perhaps with the same person who wound them up there (or say they 'have anxiety' even if that is due to you standing them on a bridge knowing they have a fear of heights), but it is even more avoidable and transparent when it is basic ill physical health being exacerbated, sometimes deliberately, in a way that is actually annotated in the new Nice guidelines. Yet the claims of a deluded HCP saying 'I don't believe' as long as they have the right badge on, mean that those basic needs can be ignored.

Which is a real worrying new power level - and that has impacts on how said people allowed it behave, and who might be attracted to it. Those are just basic facts.
It feels like that label of 'functional' is now being used to even skirt mental health law and certainly basic rights.

It is weird because the 'solution' legally should be as simple as whoever is asked to make that assessment being required to demand they are put in an appropriate environment (under someone else who isn't under the hierarchy or friends with the staff member applying for it) for 2 weeks before they are assessed officially - so why doesn't it happen? Hack even the claims of these 'powers' just being for asssessment don't require that where the word functional and possible ME/CFS is involved that such an assessment requires that person to be given the fighting chance of not being in an exacerbating to physical health environment.

 

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