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Connecting philosophy of medicine with feminist bioethics
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
The example of medically unexplained symptoms mentioned above illustrates this point: as noted above, Hofmann describes medically unexplained symptoms (e.g. muscular pain, fatigue, headaches, muscle weakness and combinations of these symptoms) as involving illness and sickness without currently accepted evidence of disease (2017: 21). However, feminist work shows that in some cases, it may be remarkably difficult for sufferers from these conditions to actually be recognized as sick; their reports of their symptoms may not be taken seriously. For example, Blease et al. (2017) discuss research showing that, despite the fact that myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is now a recognized medical syndrome, physicians and medical students may still doubt that it is “real” and that this skepticism influences the way that they interact with their patients. Similarly, Buchman, Ho and Illes (2016) quote a physician who expresses the change in attitude that they feel when a patient’s reports of pain are “confirmed” by diagnostic imaging. Seeing something “objectively definable” (2016: 1400) alters the way that they approach the patient. In the absence of objective findings of disease, patients’ descriptions of their pain are treated with skepticism. This is true even though clinicians are well aware that biological signs of pain (or of the causes of pain) often are not correlated with patients’ subjective experiences (Buchman, Ho and Goldberg 2017).
Medically Unexplored Stories
Published in John Launer, Reflective Practice in Medicine and Multi-Professional Healthcare, 2022
The evidence provided by these studies is convincing—at least when judged in terms of their own implicit assumptions. At the same time, I want to argue that the definition of Medically Unexplained Symptoms is highly problematical. It may offer no significant advance on the whole range of terms that are now becoming obsolete. It may even lead us down a medical blind alley.
Introduction
Published in Peri J. Ballantyne, Kath Ryan, Living Pharmaceutical Lives, 2021
While medicine use can reinforce stigma and discrimination associated with a condition, or can be stigmatising and delegitimising itself, one chapter shows that medicines can serve as tools for making illness experiences meaningful, and potentially legitimise illness in the face of medically unexplained symptoms. In The drama of medicines: narratives in stories of living with postural tachycardia syndrome, Karen Lloyd, Paul Bissell, Kath Ryan and Peri J. Ballantyne argue that telling stories about living with illness and taking medicines to manage illness is a critical form of embodied meaning making. Their chapter presents an analysis of ‘medication narratives’, or stories told about medicines, by persons living with postural tachycardia syndrome, a rare dysfunction of the autonomic nervous system. Drawing on Arthur Frank’s work on the dramas of illness narratives, stories told about medicines are presented as dramas that illustrate the ‘work’ that medicines do or have done with and to them. Three kinds of dramas are revealed in stories accessed from online/digital support group ‘communities of practice’ involving persons living with postural tachycardia syndrome: (1) dramas of medicines in the body, (2) dramas of signification and the self, and (3) dramas of experimentation. The authors argue that conceiving of medication narratives as dramas and illuminating how people living with illness use medicines to make sense of and negotiate their lives, is particularly effective in the context of medical uncertainty for conditions such as postural tachycardia syndrome.
Embodied Knowledge – the Phenomenon of Subjective Health Complaints reflected upon by Norwegian Psychomotor Physiotherapy specialists
Published in Physiotherapy Theory and Practice, 2022
Kirsten Ekerholt, Astrid Bergland
The focus of the present study was to explore Norwegian Psychomotor Physiotherapy (NPMP) specialists’ reflections on the concept of subjective health complaints (SHCs). We wanted to access their experiences from working with patients with this diagnosis as well as their experiences from collaborating with medical doctors who had referred patients with SHCs for NPMP. Rosendal et al. (2017) stated that many patients consult their medical doctors because they experience bodily symptoms, yet the clinical picture does not meet the existing diagnostic criteria for diseases or disorders. Accordingly, the medical doctors find no results from clinical investigation, and the complaints are attributed to “medically unexplained symptoms.” This concept has been replaced by the concept of “subjective health complaints,” which is considered a better and more neutral medical term, because it does not entail assumptions about disease, etiology, or diagnoses (Eriksen and Ursin, 2004).
How to learn skilled communication in primary care MUS consultations: a focus group study
Published in Scandinavian Journal of Primary Health Care, 2021
Juul Houwen, Peter L. B. J. Lucassen, Hugo W. Stappers, Karel van Spaendonck, Aniek van Duijnhoven, Tim C. olde Hartman, Sandra van Dulmen
We approached GPs (who did not participate in our previous studies [11,14,15] in the region of Nijmegen to invite patients with MUS. Patients were identified who had in the doctor’s opinion medically unexplained symptoms and who presented their medically unexplained symptoms frequently in recent years. After consenting to participate, a researcher (JH) invited the MUS patients. Two researchers (JH or ToH) invited GPs, MUS experts and teachers by phone or by email. To obtain sufficient variation, we purposively approached participants with different backgrounds regarding sex, age, years of work experience. We invited 7 GPs of whom 5 agreed to participate in the GP focus group. Six other GPs invited 8 MUS patients for the patient focus group (4 patients agreed to participate). We invited 13 MUS experts (11 participated) and 10 teachers (6 participated), see Table 1.
Functional neurological symptoms masquerading as Wernicke encephalopathy following bariatric surgery
Published in Baylor University Medical Center Proceedings, 2019
Andrew M. Kiselica, Sabra Rosen, Jared F. Benge
Test findings, combined with normal neuroimaging, electroencephalogram, and laboratory results, suggested that the patient’s presentation was not consistent with neurological damage. WE seemed unlikely, given the absence of observed oculomotor abnormalities, gait disturbances, dyscoordination, or evidence of thiamine deficiency. Rather, her symptoms may best be conceptualized as a conversion disorder.4 This diagnosis is consistent with prior research. She reported an extensive psychiatric history and recent stressful life events, two important risk factors for developing medically unexplained symptoms.5–7 Additionally, she demonstrated heavy health care resource utilization8 and disavowed psychiatric explanations for her symptoms in favor of more traditionally “organic” explanations.9