Training of clinicians about the challenges faced by patients who are suffering from medically unexplained symptoms (referred to as CMI in this report) appears to have changed their attitudes toward the patients (Fazekas et al., 2009). In one study, although physicians recognized the challenges and suffering of veterans who had medically unexplained symptoms, they were wary of the difficulty in treating the patients (Aiarzaguena et al., 2009). 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).

In one RCT, training of physicians in communication skills and in treating patients who have CMI resulted in greater patient satisfaction (Frostholm et al., 2005). Patients who had more uncertainty and negative emotions (feeling worried, depressed, helpless, afraid, or hopeless) about their health problems were less satisfied with the consultations with their physicians.

Evidence on the effectiveness of current methods of teaching clinicians how to communicate is sparse. In a recent comprehensive review of physician communication, Christianson et al. (2012) described the complexities of improving physician–patient communication. They documented that although training in communication skills is an important component of improving patient care, such training alone is insufficient. Additional factors need to be addressed, including

•  Patient characteristics, such as sex, ethnicity, age, physical appearance, education or language and literacy, and the presence of a terminal illnesses or chronic condition (such as CMI).

•  Practice characteristics, such as physical surroundings that are crowded and noisy, the availability of “decision aids” or electronic health records, and in-office laboratories and imaging equipment.

•  Environmental characteristics, which may be financial (for example, fee-for-service reimbursement, pressure to see more patients in the practice day leading to reduced visit length, or increasing payment by overuse or misuse of procedures and laboratory studies) and the need to use evidence-based treatment guidelines, potentially creating time-management problems for physician practices (Ostbye et al., 2005).

Christianson et al. (2012) stated that “possible interventions to improve physician communication … typically focus exclusively on the role of physician characteristics and give relatively little attention to mediating factors related to practice setting or patient characteristics. By doing so, they risk … overlook[ing] potentially fruitful interventions to improve communication that could be directed at altering mediating factors.”



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