Connecting philosophy of medicine with feminist bioethics
Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills in 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).
Depression
Christopher Dowrick in Global Primary Mental Health Care, 2019
6. Reflect on the difference between being given a diagnosis, versus just being heard and understood.There is considerable overlap in symptoms between depression and anxiety. The MaGPie study from New Zealand found 18.1% of primary care patients met the criteria for depression over the past 12 months but 56% of them had a co-existing DSM IV level anxiety and 20% a substance use and dependence disorder.22 Some people with medically unexplained symptoms may be anxious or depressed. There may be a new term in the ICD-11 called “anxious depression” which includes mixed anxiety and depression.23
Diagnosis
Wilfrid Treasure, Roger Jones in Diagnosis and Risk Management in Primary Care, 2017
Patient-centred medicine focuses on the person, and illness-centred medicine on pathology.4 Personal illness is caused by human situations, and disease illness by organic pathology.97 Illness is the feeling someone has when they’re unwell, disease is dysfunction of an organ,28 and functional symptoms are bodily dysfunctions unexplained by pathology.174,176 Dissimulating disorders include malingering (in which symptoms and signs are simulated in order to achieve a goal), factitious disease (which is really a fiction created in the pursuit of patienthood for its own sake), and hysteria or somatisation (in which distress is involuntarily exhibited in physical form).177 These definitions in isolation might sound convincing, but strung together they reveal their own and each others’ inconsistencies. It’s tempting to use a term such as medically unexplained physical symptoms.178 That seems to define something precise but, apart from being cumbersome and negative, it creates the misleading impression that the symptoms referred to might be explained, if not medically, then in some other way. An alternative term, functional illness, has none of those disadvantages and is more acceptable to patients.174
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
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- Functional Disorder
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