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Blame, shame and hopelessness: medically unexplained symptoms and the 'heartsink' experience

Louise Stone1

  • 1MBBS, BA, MPH, DipRACOG, FRACGP, FACRRM, PhD candidate, Values, Ethics and the Law in Medicine, University of Sydney; and Senior Medical Advisor, GPET, NSW.

Australian Family Physician
|April 5, 2014
PubMed

Insights

Managing patients with medically unexplained symptoms (MUS) is challenging for both doctors and patients. Validating patient suffering and providing empathic care are key strategies for effective treatment.

Area of Science:

  • Medical Humanities
  • Psychosomatic Medicine
  • Clinical Psychology

Background:

  • Medically unexplained symptoms (MUS) pose significant challenges in clinical practice.
  • Patients with MUS often experience distress without a clear diagnostic narrative.
  • 'Heartsink' phenomenon describes the negative emotional responses clinicians may have towards these patients.

Observation:

  • Patients with MUS struggle to find social legitimacy and validation for their suffering.
  • A lack of diagnosis can lead to feelings of worthlessness, shame, and self-blame in patients.
  • Patients with a history of abuse are particularly vulnerable to these negative experiences.

Findings:

  • Consultations for MUS frequently involve mutual feelings of frustration and helplessness.
  • Effective management requires validating the patient's suffering and distress.
  • Developing appropriate explanations for symptoms and providing empathic care are crucial.

Implications:

  • Careful management can minimize the risk of iatrogenic harm.
  • Addressing the psychosocial aspects of MUS is essential for patient well-being.
  • Improved understanding and strategies can enhance the therapeutic relationship in managing MUS.
Abstract

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