Abstract
ABSTRACTPurpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.
Highlights
Medical uncertainty—understood as a state of doubt and ambiguity about the aetiology, diagnosis, treatment, and/or prognosis of illness—is an inherent quality of all biomedical knowledge and clinical practice, to various degrees (Han, Klein, & Arora, 2011)
The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway
Such partnerships are difficult to achieve: medical encounters related to medically unexplained physical symptoms (MUPS) are associated with conflicts between patients and doctors who struggle to cooperate with each other (Dowrick et al, 2008; Lian & Nettleton, 2015; Libert et al, 2016)
Summary
Medical uncertainty—understood as a state of doubt and ambiguity about the aetiology, diagnosis, treatment, and/or prognosis of illness—is an inherent quality of all biomedical knowledge and clinical practice, to various degrees (Han, Klein, & Arora, 2011). In clinical consultations epitomized by great uncertainty, therapeutic relationships between patient and doctor become paramount (Kornelsen, Atkins, Brownell, & Woollard, 2016) Such partnerships, are difficult to achieve: medical encounters related to MUPS are associated with conflicts between patients and doctors who struggle to cooperate with each other (Dowrick et al, 2008; Lian & Nettleton, 2015; Libert et al, 2016). For doctors who are trained to work on the basis of evidence-based biomedical knowledge and technological proof, somatic symptoms unsubstantiated by observable biomarkers to verify organic disease are challenging. Experiences of uncertainty can increase psychological distress, intensify sensitivity to pain (Rosendal et al, 2013; Taylor, Marshall, Mann, & Goldberg, 2012; Weiland et al, 2012; Wright, Afari, & Zautra, 2009), and result in poorer health (Neville, 2003), reduced quality of life and diminished confidence (Ogden et al, 2002)
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