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Here is a new paper from Canadian Psychiatrist Dr. Eleanor Stein...
Email from Dr Eleanor Stein
This paper, 3 years in the writing, is a contribution towards understanding and improving the notoriously problematic therapeutic relationships between patients with ME/CFS and health care practitioners. My patients continually tell me of problems they encounter with other practitioners (and sometimes with myself). Eva Stormorken a nurse and PhD candidate who runs groups for ME/CFS and myself have listened to our patients and colleagues and have highlighted the most common therapeutic challenges that arise. We then formulated solutions to those challenges based on our practice experience. Dr. Bengt Karlsson, an academic, helped us find language to describe our patient centered, collaborative approach. The concepts in this paper transcend profession and therapeutic ideology. We hope the paper will be widely read and will contribute to improved relationships and clinical outcomes in our field.
Like the Guidelines for Psychiatrists paper I wrote in 2005, we submitted this paper to several journals and it was declined by all. Likely this is in part due to it being a practice based and not a research based paper. Though there are many papers documenting the discord between patients with ME/CFS and professionals, there are none recommending how to overcome these challenges. This paper, like the Guidelines paper is introducing clinically relevant ideas which may improve satisfaction and outcomes for patients and practice satisfaction for health care professionals.
How to improve therapeutic encounters between patients with
Myalgic Encephalomyelitis / Chronic Fatigue Syndrome and Health Care Practitioners
Eleanor Stein MD FRCP(C), Eva Stormorken RN CRNA MNSc PhD Candidate, Bengt Karlsson RN Family Therapist Dr. Polit
Abstract
Background: Clinical practice and the medical literature abound with reports of mutual dissatisfaction between individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and health care practitioners.
Purpose: In this paper we: 1) formulate and describe the common therapeutic challenges in the care of patients with ME/CFS and 2) present a patient centered, collaborative practice model that may mitigate these challenges.
Method: We have combined clinical experience with hundreds of patients, a thorough review of the medical and psychotherapy literature and comments from patients and colleagues to arrive at our proposed practice model.
Findings and Discussion:
We have identified six common therapeutic challenges listed below. From our experience and the psychotherapy literature we have identified a relatively simple patient centered intervention for each therapeutic challenge. These interventions are recommended for health care practitioners working with patients with ME/CFS who find themselves in difficulty.
1. Disagreement about the validity and severity of ME/CFS - Validate the patient’s experience and openly discuss differences of opinion.
2. Disagreement about the etiology and best management of ME/CFS – Find and validate the truth in the patient’s position.
3. Frustration due to lack of improvement - Collaboratively search for hope.
4. Altered power balance between practitioner and patient - Clarify and increase practitioner expertise.
5. Working with patients who feel unheard - Listen to the whole story.
6. Gap between needed and available services - Build a coalition to access needed services.
Conclusions: Therapeutic relationships with patients with ME/CFS can be rewarding and enjoyable. The interventions highlighted in this paper may assist practitioners who feel otherwise.
Key Words: Chronic Fatigue Syndrome, collaborative practice, health care practitioners, Myalgic Encephalomyelitis, patient centered therapy, therapeutic relationships
The full text is posted at: http://eleanorsteinmd.ca/wp-content/uploads/downloads/2013/09/Therapeutic-Relationships-FINAL-Sept-2013.pdf
We look forward to comments and feedback. Ellie Stein
Eleanor Stein MD FRCP(C)
Psychiatrist in Private Practice and
Assistant Clinical Professor, University of Calgary
4523 16A St. SW
Calgary, AB T2T 4L8
Ph: 403 287-9941
FAX: 403 287-9958
Email: espc@eleanorsteinmd.ca
Web: www.eleanorsteinmd.ca
Email from Dr Eleanor Stein
This paper, 3 years in the writing, is a contribution towards understanding and improving the notoriously problematic therapeutic relationships between patients with ME/CFS and health care practitioners. My patients continually tell me of problems they encounter with other practitioners (and sometimes with myself). Eva Stormorken a nurse and PhD candidate who runs groups for ME/CFS and myself have listened to our patients and colleagues and have highlighted the most common therapeutic challenges that arise. We then formulated solutions to those challenges based on our practice experience. Dr. Bengt Karlsson, an academic, helped us find language to describe our patient centered, collaborative approach. The concepts in this paper transcend profession and therapeutic ideology. We hope the paper will be widely read and will contribute to improved relationships and clinical outcomes in our field.
Like the Guidelines for Psychiatrists paper I wrote in 2005, we submitted this paper to several journals and it was declined by all. Likely this is in part due to it being a practice based and not a research based paper. Though there are many papers documenting the discord between patients with ME/CFS and professionals, there are none recommending how to overcome these challenges. This paper, like the Guidelines paper is introducing clinically relevant ideas which may improve satisfaction and outcomes for patients and practice satisfaction for health care professionals.
How to improve therapeutic encounters between patients with
Myalgic Encephalomyelitis / Chronic Fatigue Syndrome and Health Care Practitioners
Eleanor Stein MD FRCP(C), Eva Stormorken RN CRNA MNSc PhD Candidate, Bengt Karlsson RN Family Therapist Dr. Polit
Abstract
Background: Clinical practice and the medical literature abound with reports of mutual dissatisfaction between individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and health care practitioners.
Purpose: In this paper we: 1) formulate and describe the common therapeutic challenges in the care of patients with ME/CFS and 2) present a patient centered, collaborative practice model that may mitigate these challenges.
Method: We have combined clinical experience with hundreds of patients, a thorough review of the medical and psychotherapy literature and comments from patients and colleagues to arrive at our proposed practice model.
Findings and Discussion:
We have identified six common therapeutic challenges listed below. From our experience and the psychotherapy literature we have identified a relatively simple patient centered intervention for each therapeutic challenge. These interventions are recommended for health care practitioners working with patients with ME/CFS who find themselves in difficulty.
1. Disagreement about the validity and severity of ME/CFS - Validate the patient’s experience and openly discuss differences of opinion.
2. Disagreement about the etiology and best management of ME/CFS – Find and validate the truth in the patient’s position.
3. Frustration due to lack of improvement - Collaboratively search for hope.
4. Altered power balance between practitioner and patient - Clarify and increase practitioner expertise.
5. Working with patients who feel unheard - Listen to the whole story.
6. Gap between needed and available services - Build a coalition to access needed services.
Conclusions: Therapeutic relationships with patients with ME/CFS can be rewarding and enjoyable. The interventions highlighted in this paper may assist practitioners who feel otherwise.
Key Words: Chronic Fatigue Syndrome, collaborative practice, health care practitioners, Myalgic Encephalomyelitis, patient centered therapy, therapeutic relationships
The full text is posted at: http://eleanorsteinmd.ca/wp-content/uploads/downloads/2013/09/Therapeutic-Relationships-FINAL-Sept-2013.pdf
We look forward to comments and feedback. Ellie Stein
Eleanor Stein MD FRCP(C)
Psychiatrist in Private Practice and
Assistant Clinical Professor, University of Calgary
4523 16A St. SW
Calgary, AB T2T 4L8
Ph: 403 287-9941
FAX: 403 287-9958
Email: espc@eleanorsteinmd.ca
Web: www.eleanorsteinmd.ca