New paper by Dr Geraghty:ME &BPS :a review of patient harm & distress in the medical encounter

Countrygirl

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https://www.tandfonline.com/doi/abs/10.1080/09638288.2018.1481149?journalCode=idre20

Review Article

Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter
Keith J. Geraghty &Charlotte Blease
Received 28 Mar 2017, Accepted 22 May 2018, Published online: 21 Jun 201
Abstract
Objective: Despite the growing evidence of physiological and cellular abnormalities in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), there has been a strong impetus to tackle the illness utilizing a biopsychosocial model. However, many sufferers of this disabling condition report distress and dissatisfaction following medical encounters. This review seeks to account for this discord.

Methods: A narrative review methodology is employed to synthesize the evidence for potential iatrogenesis.

Results: We identify seven potential modalities of iatrogenesis or harm reported by patients:

  1. difficulties in reaching an acceptable diagnosis;

  2. misdiagnosis, including of other medical and psychological conditions;

  3. difficulties in accessing the sick role, medical care and social support;

  4. high levels of patient dissatisfaction with the quality of medical care;

  5. negative responses to controversial therapies (cognitive behavioral therapy and graded exercise therapy);

  6. challenges to the patient narrative and experience;

  7. psychological harm (individual and collective distress).


Conclusion: The biopsychosocial framework currently applied to ME/CFS is too narrow in focus and fails to adequately incorporate the patient narrative. Misdiagnosis, conflict, and harm are observable outcomes where doctors’ and patients’ perspectives remain incongruent. Biopsychosocial practices should be scrutinized for potential harms. Clinicians should consider adopting alternative patient-centred approaches.

  • Implications for rehabilitation
  • Patients with ME/CFS may report or experience one or more of the modalities of harms and distress identified in this review.

  • It is important health and rehabilitation professionals seek to avoid and minimize harms when treating or assisting ME/CFS patients.

  • There are conflicting models of ME/CFS; we highlight two divergent models, a biopsychosocial model and a biomedical model that is preferred by patients.

  • The ‘biopsychosocial framework’ applied in clinical practice promotes treatments such as cognitive behavioral therapy and exercise therapy, however, the evidence for their success is contested and many patients reject the notion their illness is perpetuated by dysfunctional beliefs, personality traits, or behaviors.

  • Health professionals may avoid conflict and harm causation in ME/CFS by adopting more concordant ‘patient-centred’ approaches that give greater prominence to the patient narrative and experience of illness.


Keywords: Chronic fatigue syndrome, biopsychosocial model, harm, iatrogenesis, treatment, doctor–patient relationship
 

alkt

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the abstract looks like common sense but in effect tells doctors to lie to patients in order to gain trust and does not go into any detail about the fraudulent contested bps research .
 

Learner1

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I hope "patient-centered approaches" means treating the medical issues found in patients with drugs, hormones, supplements, and other medical treatments.
 

Mithriel

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He means by listening to patients and believing them. Patients know what is helping them and what is doing them harm. He is a complete supporter of biomedical treatment and research for ME.
 

Mithriel

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the abstract looks like common sense but in effect tells doctors to lie to patients in order to gain trust and does not go into any detail about the fraudulent contested bps research .
It really does not say that. Keith Geraghty is a staunch supporter of ME patients and a thorn in the side of the BPSers. He wants the patients to be believed and treated as experts in their own condition. The doctors are not encouraged to lie but to actually change how they look at and consider patients.

It is important to have this sort of thing our there in a peer reviewed scientific paper so it has authority. The fraudulent BPS research is referenced elsewhere. This is not talking to us but to doctors so the language has to be measured to be acceptable to them to ultimately get us the changes we want in the system.
 

Tom Kindlon

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Tom Kindlon

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Tom Kindlon

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Tom Kindlon

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Difficulties in accessing the sick role, medical care and social support

The biopsychosocial framework is increasingly used to assess ME/CFS patients’ right to adopt the ‘sick role’ [53,54]. In the UK, doctors play a role in assessing claimants for sickness benefits and advise Government on social policies. The biopsychosocial model has been used to develop a training manual of the UK Department for Work and Pensions (DWP) for disability analysts [55]; has helped shape NICE guidelines for ME/CFS [2]; and has been used to design guidelines for medical insurance claims assessors in the Netherlands [56–58]. In this regard, BPS perspectives are being used in assessing patients’ rights to access medical and social care. Interestingly, sufferers often report finding it difficult to access sickness benefits [31,32].
 

Tom Kindlon

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Tom Kindlon

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Tom Kindlon

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Tom Kindlon

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Tom Kindlon

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