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New Paper from Dr. Eleanor Stein on Practicioner / Patient Relationship

Discussion in 'General ME/CFS News' started by elbosque, Sep 16, 2013.

  1. elbosque

    elbosque

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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
     
  2. peggy-sue

    peggy-sue

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    I think this has been posted already - I seem to remember commenting that it's just more of the same old, same old.
    "Listen to your patient"; "validate their feelings"; then ignore everything and give them GET and CBT anyway.
     
  3. elbosque

    elbosque

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    I am not one of her patients but I am sure GET & CBT is not her method of operation.
     
    Valentijn likes this.
  4. peggy-sue

    peggy-sue

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    She is a psychiatrist - what other "treatment" is there?
    I've read the whole paper about 3 times, and all I can get out of it is they should listen to the patient, gain their trust, then override them, "take back the balance of power" etc.
     
  5. Valentijn

    Valentijn Activity Level: 3

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    Amersfoort, Netherlands
    She seems to be focused on coping with the illness and making realistic adjustments along the lines of pacing, such as:
    I also see nothing about practitioners taking back the balance of power. She seemed to think it can be a useful thing to have well-educated patients, and that if the therapist has an ego problem with that, they need to get over it. She also puts the burden on the therapists to learn more about the disease their patients have.
     
    WillowJ and SOC like this.
  6. elbosque

    elbosque

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    It is easy when we see "psychiatrist" attached to a name to write them off immediately. I can understand that reflex. But people need to realize that not every psychiatrist or psychologist is out to make ME as part of their physiological or psychiatric treatments turf. The audience for this paper is health professionals and it is meant for them to learn how to better interact with us and treat our very real biological illness so we don't also end up suffering from mental health issues too. I believe she became interested in CFS when she herself became ill with it. I have never heard one patient speak ill of her on any forum or Facebook page or group. So please, lets not judge a person by what they do. It is as bad as people telling us "But, you don't look sick."
     
  7. Snow Leopard

    Snow Leopard Senior Member

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    It is actually a quite reasonable paper, I wish it were more circulated among medical practitioners.
     
    Valentijn likes this.
  8. peggy-sue

    peggy-sue

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    I'll come back to this later, I really can't deal with going through tiny details at the moment, perhaps that's were I don't see the difference between this and, for example, the things said in nurse Chalder's little videos on how to flannel patients - listen to them, validate their feelings, then carry on as before, once you've gained their trust. :alien:
     

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