Review Stigmatisation in medical encounters for persistent physical symptoms/functional disorders: scoping review and thematic synthesis, 2024, Treufeldt

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Patient Education and Counseling
Available online 7 February 2024, 108198

Stigmatisation in medical encounters for persistent physical symptoms/functional disorders: scoping review and thematic synthesis

Hõbe Treufeldt, Christopher Burton
a Division of Population Health, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield, S5 7AU, UK

Received 7 August 2023, Revised 31 January 2024, Accepted 5 February 2024, Available online 7 February 2024.

https://doi.org/10.1016/j.pec.2024.108198Get rights and content


Highlights

• 32 studies were identified addressing stigma in clinical communication settings regarding PPS/FDs, however few used clear definitions of stigma.
  
  
• Stigma was reported across multiple conditions and contexts suggesting it is a structural issue.
  
  
• Patients with these conditions have to work hard in consultations to maintain their credibility.
  
  
• Only one study observed consultations to see how stigma is being communicated

Abstract

Objective
To conduct a scoping review of stigma in medical encounters for persistent physical symptoms and functional disorders (PPS/FD). Stigma is a social attribute that links a person to an undesirable characteristic. It has been extensively studied in relation to mental illness but less so in relation to PPS/FD.

Methods
We followed PRISMA-ScR reporting guidelines for scoping reviews. Searches for were designed using the SPIDER tool. We used descriptive and thematic analysis.

Results
The searches identified 68 articles, of which 32 were eligible for inclusion. 31 out of the 32 studies used a qualitative methodology. 8 studies used an explicit definition of stigma, of which 6 used the Goffman (1963) definition. Only 2 studies directly examined clinical consultations, the remainder relied on recalled accounts by patients or professionals.

Descriptive analysis identified the focus of the studies included: patient-physician interaction (n=13); health care professionals' perceptions (n=7); experiences of illness/stigma (n=6); broader meaning of illness (n=3); and patients’ experiences of stigma in health care consultations (n=3).

Conclusion
Patients experience stigmatisation in consultations for a wide range of PPS/FD. This suggests the presence of structural stigmatisation.

Practice Implications
There is a need for effective stigma reduction strategies in consultations about persistent physical symptoms.

Keywords
Stigma
medical consultation
persistent physical symptoms
functional disorders
medically unexplained symptoms
scoping review

 

Yes. Quite.

 

Congratulations to the authors, as they add to the stigma they have identified by labelling the conditions covered as "persistent physical symptoms and functional disorders".

 

They seem completely oblivious that the very construct of psychosomatic illness is itself discrimination and the source of most of its stigma. Society doesn't do that just because, they do that because this is how medicine treats us, describes us and advises how to approach us. Not recognizing that is just insulting when it's usually plainly stated, but they pretend not to listen and that they can somehow discriminate against people without us knowing it, which is never going to happen.

Might as well be corrupt billionaires with huge influence on fiscal policy talking about poverty. They're too detached from reality.

 

To be fair it is all less insane until the bit from conclusion to practical implications.

These terms are codewords used to say 'radioactive patient, don't listen to what they say'

I'm therefore not sure that there is a stigma reduction strategy in consultations about persistent physical symptoms - the poor patient has just stepped into a mass delusion/dystopia

And there is an obvious solution/issue staring them in the face that they are wanting to dance around like they can't see the elephant in the room. Just get rid of and work on sorting the entire gamut of those who've preyed on demographics vulnerable enough to shove under such pretend terms. And make an example of them. Seems the obvious required solution. In the case of everyone thinking this is 'impossible' for some reason then everything else clearly becomes also impossible because said individuals are literally 'owned' in their fate by how 'benevolent' said masters might be to compromise (unlikely)?