Gulf War and Health Treatment for Chronic Multisymptom Illness (2013) / Chapter Skim
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6 Patient-Centered Care of Veterans Who Have Chronic Multisymptom Illness
6 Patient-Centered Care of Veterans Who Have Chronic Multisymptom Illness
Pages 133-154
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From page 133... ...
It also considers how the new information and communication technologies could be harnessed to improve care. CLINICIAN TRAINING, PRACTICE BEHAVIORS, AND CHRONIC MULTISYMPTOM ILLNESS The treatment of veterans for CMI requires a multipronged approach.
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From page 134... ...
. Even participation in a "brief exposure," such as a seminar, may make clinicians more receptive to and sympathetic toward patients who have medically unexplained symptoms, according to a study of medical students (Friedberg et al., 2008)
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The effectiveness of another form of clinician training, consultation with a mental health professional with or without consultation letters, also has been studied. Consultation letters educate the referring clinician about the chronic nature of the symptoms and suggest treatment strategies for the care team to use that are based on frequency of follow-up visits and psychosocial models rather than high-cost testing and procedures.
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From page 136... ...
That premise is supported by results of several studies that show that good communication skills and an effective patient–clinician relationship can lead to improved patient satisfaction, better disclosure of important information, greater adherence to treatment, reduced emotional distress, improved physiologic measures, and better overall clinical outcomes (Anderson et al., 2008; Frostholm et al., 2005; Hall et al., 2002; Roter and Hall, 1989, 1992; Roter et al., 1995)
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. Patient Perceptions Regarding the Patient–Clinician Relationship and Chronic Multisymptom Illness On the basis of clinical studies, patient presentations to the committee,1 and a social media analysis commissioned by the committee (Furey, 2012)
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. • Many patients are seeking alternative treatments because they are dissatisfied with the type of care received from their health care clinicians.
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. With regard to effective communication methods for CMI, one qualitative study evaluated the management methods of community-based physicians who were treating patients who had medically unexplained symptoms (Anderson et al., 2008)
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Many clinicians have difficulty in accepting CMI as a bona fide disorder because there is no biomarker or specific diagnostic test. The difficulty is common in clinicians who work with functional somatic syndromes, such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome.
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The clinician provides empathy by demonstrating an understanding of the patient's pain and distress while main taining an objective and observant stance. An empathic statement would be, "I can see how difficult it has been for you to manage with all these symptoms" or "I can see how much this has affected your life." Providing empathy improves patient satisfaction and adherence to treatment.
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From page 142... ...
") Use of patient's words Use of unfamiliar words Fewer questions and interruptions More Question style Nonjudgmental Judgmental Follows lead of patient's earlier responses Follows preset agenda or style Use of a narrative thread Unorganized questioning Appropriate use of silence Frequent interruptions Appropriate reassurance Premature or unwarranted reassurance Eliciting pertinent psychosocial data in a sensitive and Ignoring psychosocial data or using "probes" skillful manner
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From page 143... ...
The clinician needs to understand such patient behaviors as responses to deficits in the health care system in providing proper care rather than as patient problems. The clinician must also "tune in" to personal thoughts and feelings (for example, "What is it about this patient's behavior that makes me feel frus trated?
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Additional resources for clinicians to learn more about improving their communication skills are listed in Box 6-1.
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http:// www.healthcarecomm.org/ NOTE: The resources described here are examples of the types of pro grams that are available to health care practitioners who are interested in improving their communication skills. They do not constitute an exhaus tive list of communication improvement programs.
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From page 146... ...
. Moreover, VA has advanced electronic health records and health informatics architecture that could be exploited to disseminate new models for managing CMI and encouraging patient participation.
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The penetration of social media has been fast and furious, and they have overtaken the growth of other platforms on the Web. Almost 66% of online adults use social media platforms, according to the Pew Internet & American Life Project, and much of the use is focused on staying in touch with friends and family members (Pew Research Center, 2012)
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aInternet users make up 66% of US population. SOURCE: Reproduced with permission from Pew Research Center's Internet & American Life Project.
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2007. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPS for patients with medically unexplained symptoms.
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2008. Teaching medical students about medically unexplained illnesses: A preliminary study.
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2007. Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms.
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2006. Primary care clinicians treat patients with medically unexplained symptoms: A randomized controlled trial.
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2006. Collaborative care for medically unexplained physical symptoms in general practice.
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