The importance of contextual aspects in the care for patients with functional somatic symptoms, 2020, Gol et al

[Dolphin]

https://www.sciencedirect.com/science/article/abs/pii/S030698772030164X

Medical Hypotheses
Available online 11 April 2020, 109731
In Press, Journal Pre-proofWhat are Journal Pre-proof articles?

The importance of contextual aspects in the care for patients with functional somatic symptoms
J.M.Gol
J.G.M.Rosmalen
ROBGans
J.P.J.Slaets
R.C.Oude Voshaar
University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), PO Box 30.001 (CC72), 9700 RB, Groningen, The Netherlands
Received 3 February 2020, Revised 1 April 2020, Accepted 8 April 2020, Available online 11 April 2020.

https://doi.org/10.1016/j.mehy.2020.109731

Abstract
Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit.

We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioral environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organised office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician’s competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behavior and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms.

Keywords
Functional somatic symptoms
medically unexplained symptoms
contextual parameters
treatment

 

[Sean]

'We need to lie better to patients.'

For example:

Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained.

Oh wait,...

Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not),

In other words, they are right regardless of aetiology.

Psycho-tyranny.

 

[rvallee]

Focusing on the style because they can't admit there is no substance. Over a century of the same nonsense running in infinite loops.

Meanwhile there are literally millions of lives being harmed by the mere existence of this nonsense, stifling research and encouraging systemic discrimination that cause social ostracization, and this is what they waste their time on: how to be better manipulators.

This is exactly, and I do mean EXACTLY, how scammers, con artists, pyramid schemes and various shady people who want to sell you useless things spend most of their efforts on. Because the manipulation is the point and the main skill being deployed.

Case in point:

starting treatment as soon as possible, having a neat appearance and an organised office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician’s competence to help

Literally none of those things are medically relevant. However they are all very relevant to salespeople and especially MLMs. There are actual books on this, on sales techniques and how to turn a mark into a sale. Literally none of those things have any impact whatsoever on how a patient will assess a physician's competence. Get your damn heads out of your collective asses this is beyond embarrassing.

Also:

Collectively, some support is found

Literally "people are saying". This is a personal opinion generally gesturing to other people with the same opinion as being a valid basis for such a claim.

 

[Sean]

con artists

There are actual books on this, on sales techniques and how to turn a mark into a sale.

What a lot of people don't understand about con artists is that the con is not in the mechanics of the trick, the pea and thimbles. That's just a distraction.

The con in a con-job is psychological. It is getting the mark to believe that they can outwit the con artist.

 

[spinoza577]

At least they managed to release it in a journal with a halfway appropriate title: Medical Hypothesis.

... no, even not this:

Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained

 

[Invisible Woman]

Let me just correct that bit.

"Functional somatic symptoms refer to physical symptoms that cannot be have not yet been fully (bio) medically explained."

While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit.

Right. To anyone whose intelligence level is even marginally higher than that of a dead potted plant that should be a bit of a red flag, surely? Perhaps it's time to revisit the definition, methods & measures used to evaluate effectiveness? If it isn't benefiting patients then there simply isn't any point. Here's an idea, why not simply ask the patient if they believe the treatment is effective?

a warm and friendly nonverbal approach

Where I come from a stranger being overly friendly in this way would find themselves in a world of hurt. You might want to reconsider that.