Medically Unexplained Symptoms Flashcards
What is the difference between illness and disease?
Disease is a pathological abnormality which is presumed to be objective and is what doctors treat - revealed by searching for objective signs.
Illness is the patient’s symptoms, their subjective experience of the pathology. and it is not clear how it should be treated if there is no physical cause.
Describe some consequences of living with medically unexplained symptoms.
The uncertainty caused by having no diagnosis and so no prognosis
Lack of support and information, keep searching for and receiving explanations
Lack of legitimacy (don’t have true disease) and so unable to enter the Sick Role and receive benefits and work flexibility
Lack of social support leading to social isolation
Strained social and family relationships
Change in identity, dismissed as a malingerer
Feel guilty, unworthy of help
Periods of remission contribute to people viewing you as a malingerer
Various diagnoses may be received over the years, and each time it is changed patient may have to leave patient support group and change identity
What is a medically unexplained syndrome and give an example.
A collection of symptoms with no patho-physiological basis e.g irritable bowel syndrome, chronic fatigue syndrome
How did the change in the organisation of healthcare and the doctor-patient relationship influence the nature of medical knowledge?
(1770-1800) BEDSIDE medicine - the doctor listens to the patient describe his symptoms, and the patient is paying the doctor. The diagnosis of the disease is based only on the symptoms.
(1800-1840) HOSPITAL medicine - the doctor looks for objective signs and listens to the body not the patient to diagnose disease. Technology is helpful e.g stethoscope, X-rays.
(1870s onwards) LABORATORY medicine - patient is not requires, only their tissue (disappearance of sick man), the lab tests not the patient are listened to, life is broken down to physio-chemical processes.
Why would a patient be a “medical orphan”?
No objective sign of the MUS can be discovered so they have no true disease, and no place to go and get help.
What are the problems caused by MUS to patients?
Needs are not met, so there is a poor outcome
Subjected to a range of tests and investigations, so risk iatrogenic harm
What are the problems caused by MUS to doctors?
The tests and interventions are expensive
There is frustration at not being able to help the patient or give them a satisfactory explanation
What are the problems caused by MUS to the healthcare system?
Poor and ineffective use of resources, as MUS patients are often frequent attenders and expensive
Describe the politics of a diagnosis of Chronic Fatigue Syndrome on a macro (institutional) level.
Clinician’s perspective = Report published in 1996 by Royal Collages of Physicians, Psychiatrists, GPs defined Chronic Fatigue Syndrome as “at least six months of disabling fatigue affecting mental and physical functioning, with somatic symptoms e.g joint pain and headache, and possibly psychological symptoms”
The report rejected the term Myalgic Encephalitis (ME) as there was no evidence of a discrete organic basis (e.g viral cause).
Patient’s perspective = ME/CFS Charities Alliance report published in 1997 was adamant there is an organic basis for the syndrome so the term ME is valid. They campaigned for the recognition of organic aetiology.
Describe the politics of a diagnosis of Chronic Fatigue Syndrome on a micro (clinic) level.
The patient may present by putting emphasis on bodily symptoms (e.g pain and muscle fatigue) and the localisation of pain in the body.
Doctors will put emphasis on limitations of physical and cognitive functioning.
There is a conflict between the patient’s and doctor’s ideas.
An ethically questionable method is the doctor persuading the patient that their blood pressure is low due to a drop in serotonin, which opens the possibility of prescribing antidepressants.
What three things do patient’s usually want from a consultation?
Alliance - accept that there is no treatment or cure, but work with doctors to manage symptoms
Exculpation - reality of suffering recognised, exculpating confirming the symptoms are not the patient’s responsibility
Convincing explanation - a plausible and creditable explanation, whilst recognising it may change over time
What are the three types of explanations doctors give to patients?
Rejecting (denying reality of symptoms, all in patient’s mind, implies imaginary disorder or stigmatising psychological problem)
Collusive (doctor sanctions patient’s beliefs about symptoms, goes along with what patient says)
Empowering (actually works with patient to establish a tangible mechanism, provide exculpation, provide opportunities for self-management)
What are the implications for patients of a rejecting explanation?
Unresolved explanatory conflict
Doctor distrusted with future symptoms
What are the implications for patients of a collusive explanation?
Questioning of doctor’s openness and competence
Mistrust of doctor because he is just saying what he thinks the patient wants to hear
What are the implications for patients of an empowering explanation?
Legitimises patient suffering
Patient understands and owns explanation
Blame is removed from the patient
There is alliance between the doctor and patient
