What you say matters too

1. What you say matters too

2. ‘Normalising’, and were not talking about MUPS (Medically Unexplained Physical Symptoms)

3. Spend a few minutes on your own and think of the situations where you normalise symptoms (give patients an explanation for their symptoms where the diagnosis is imprecise). • Make a list

4. Share ideas with 3 others to generate a combined list • Try and add structure the list

5. Examples of situations where we ‘normalise’ symptoms • Normal result? • Atypical Chest pain • Temperature/fever • Memory problems in the young • Globus • Abdo pain – IBS – infantile colic-periodic syndrome • Teething • Bowel habit problemserructation • Numbness/ paraesthesiae • Pruritis/ rash • Non specific headache • Tiredness/ TATT • Palpitations • Menstrual problems • Visual symptoms • Low back pain • Aches and pains • Anatomical quirks • Patient in the illness- • Cough and cold • Tinnitus • Blocked nose • Sinusitis • Impotence • Insomnia • Hyperhidrosis

6. Gastroenterology; abdominal pain, IBS, bowel habit problems • Paediatrics; teething , infantile colic, abdominal migraine/periodic syndrome • ENT; dizziness, vertigo, tinnitus, globus hystericus, blocked nose • Neurology; headaches, numbness, memory problems in the young • Ophthalmology; visual symptoms • Psychiatry; TATT, panic attacks, insomnia, impotence • CVS; non cardiac chest pain, palpitations • Orthopaedics/rheumatology; low back pain, knee pain, generalised aches and pains • Dermatology; ideopathic pruritis, hyperhidrosis • Gynaecology; pelvic pain, menstrual problems e.g. dysmenorrhoea, menorrhagia • Obstetrics; dyspepsia, low back pain • Urology; testicular/perineal pain in men, cystitis (non UTI) in women

7. Andy’s group • Gastroenterology; abdominal pain, IBS, bowel habit problems • Paediatrics; teething , infantile colic, abdominal migraine/periodic syndrome • ENT; dizziness, vertigo, tinnitus, globus hystericus, blocked nose

8. David’s group • Neurology; headaches, numbness, memory problems in the young • Ophthalmology; visual symptoms • Psychiatry; TATT, panic attacks, insomnia, impotence

9. Malcolm’s group • CVS; non cardiac chest pain, palpitations • Orthopaedics/rheumatology; low back pain, knee pain, generalised aches and pains • Dermatology; ideopathic pruritis, hyperhidrosis

10. Will’s group • Gynaecology; pelvic pain, menstrual problems e.g. dysmenorrhoea, menorrhagia • Obstetrics; dyspepsia, low back pain • Urology; testicular/perineal pain in men, cystitis (non UTI) in women

11. For presentations • Record the words/phrases that you use in some of these situations. • Consider the scientific basis for your ideas and explanations. • Find out from other doctors e.g. trainer what seems to work well in these situations. • Consider the objectives (what we are trying to achieve for doctors and patients) in normalising patients’ symptoms. • Consider the hazards of normalising and how we might overcome them.

12. Objectives • To investigate the phrases we use to explain to patients the nature of common medical symptoms. • To see where there is concordance, or variation of approach • To consider the scientific basis behind some of our explanations • To involve you in active learning, linking the VTS to the experience of yourselves and other doctors in your practices • To highlight the potential of qualitative research in this area

13. Learning Outcomes By the end of this session: • You will be familiar with the concept of and the importance of normalising • Have picked up some useful phrases to help explain symptoms • You will have reflected on the scientific rigor of the practice of medicine in the 21st century

14. What worries parents when their preschool children are acutely ill, and why: a qualitative studyBMJ, Oct 1996; 313: 983 - 986 Joe Kai • Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative studyBMJ, Oct 1996; 313: 987 - 990 Joe Kai

15. What worries parents when their preschool children are acutely ill, and why: • Results: Fever, cough, and the possibility of meningitis were parents' primary concerns when their children became acutely ill. Parents' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents' responsibility to protect their child from harm. They were grounded in two linked factors: parents' sense of personal control when faced with illness in their child and the perceived threat posed by an illness. • Conclusions: Better understanding of parents' concerns may promote effective communication between health professionals and parents. Modification of parents' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.

16. Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study • Results: Parents felt disempowered when dealing with acute illness in their children because of difficulties making sense of the illness. Central to parents' difficulties were their experiences of inadequate information sharing by their general practitioners and variations in their doctors' decisions and behaviour. Disparity between parents' beliefs and expectations about illness and treatment and professionals' behaviour further frustrated parents' attempts to understand illness. Parents expressed a need for a range of accessible and specific information to support them through their negotiation of children's illness. • Conclusions: Communication with parents requires greater recognition of parents' difficulties. Professionals have considerable potential to empower parents by sharing more information and skills. Such information should be consistent and address parents' concerns, beliefs, and expressed needs if this potential is to be realised.