Abstract
ObjectiveThe apparent absence of any specific underlying diseases challenges patient-provider communication about medically unexplained symptoms (MUS). Previous research focused on general communication patterns in these interactions; however, an overview of more detailed interactional and linguistic aspects is lacking. This review aims to gain a detailed understanding of communicative challenges in MUS consultations by synthesizing evidence from conversation and discourse analytic research. MethodsA systematic review of publications using eight databases (PubMed, Embase, CINAHL, PsychINFO, Web of Science, MLA International Bibliography, LLBA and Communication Abstracts). Search terms included ‘MUS’, ‘linguistics’ and ‘communication’. Additional studies were identified by contacting experts and searching bibliographies. We included linguistic and/or interactional analyses of natural patient-provider interactions about MUS. Two authors independently extracted the data, and quality appraisal was based on internal and external validity. ResultsWe identified 18 publications that met the inclusion criteria. The linguistic and interactional features of MUS consultations pertained to three dimensions: 1) symptom recognition, 2) double trouble potential (i.e. patients and providers may have differing views on symptoms and differing knowledge domains), and 3) negotiation and persuasion (in terms of acceptable explanations and subsequent psychological treatment). We describe the recurrent linguistic and interactional features of these interactions. ConclusionsDespite the presence of a double trouble potential in MUS consultations, validation of symptoms and subtle persuasive conduct may facilitate agreement on illness models and subsequent (psychological) treatment.
Highlights
The apparent absence of a specific underlying disease challenges patient-provider communication about medically unexplained symptoms (MUS)
NB: UK = United Kingdom, US = United States of America, CFS = Chronic fatigue syndrome, MUS = medically unexplained symptoms, FNS = functional neurological symptoms, PNES = psychogenic non-epileptic seizures, IBS = irritable bowel syndrome, LBP = Low back pain, Conversation analysis (CA) = conversation analysis, DA = discourse analysis, NA = narrative analysis. a Based on same dataset b Compared PNES and epilepsy; this review only considered PNES consultations c Focused on labelling of PNES, excluded patients with other FNS d CA-based framework approach
Based on the evidence reported in 12 studies, we noted that consultations about MUS carry a double trouble potential that may hinder successful communication between healthcare providers and patients
Summary
The apparent absence of a specific underlying disease challenges patient-provider communication about medically unexplained symptoms (MUS). Whereas patients feel that their symptoms have biomedical causes, healthcare providers tend to highlight the importance of the psychosocial context in which symptoms have emerged [1]. Healthcare providers often feel unable to provide the right support [4] and no single effective treatment strategy exists for these patients [5], who account for 3–20% of all medical consultations [6,7]. This leaves the clinical encounter, and the communication between healthcare providers and patients, as a major site for symptom management [8]. A systematic review of how linguistic and interactional aspects characterize natural patient-provider interactions about MUS can reveal important insights into communication patterns in various medical settings and provide a deeper understanding of such patterns [11,12]
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