Stigma and stigmatisation in medical consultations for persistent physical symptoms/functional disorders

Brief overview of the thesis

This thesis was designed to understand stigma in persistent physical symptoms (PPS)
and to develop actionable ways of lessening the stigma and improving the care that
people with PPS receive.

Aim
The series of studies presented in this thesis investigate the pervasive role of stigma in
clinical encounters for Persistent Physical Symptoms (PPS) and Functional Disorders
(FDs), as well as explore communication strategies that can mitigate negative patient
experiences.

Methods
This thesis consists of five studies, that used complementary methods: scoping review,
framework synthesis, conversation analysis, a qualitative focus group study and
development of an actionable framework for interventions to reduce stigma.

Key findings
The collective findings across these five studies highlight the urgent need for stigma
reduction strategies in consultations about PPS/FDs.
The first study: scoping review found that the stigma in PPS/FDs can be described as
pervasive, ubiquitous, and structural. The second study was a best fit framework
synthesis and proposed a framework to categorise and understand the patients’
stigmatising experiences. The stigma framework consists of three stigma-carrying
stereotypes and six stigmatising actions. The third study was a qualitative focus group
study to understand patients’ lived experiences. The findings further validated the stigma
framework in study two and highlighted a relationship between experienced stigma and
(re)traumatisation. The fourth study used conversation analysis to micro-analyse the
difficulties that patients with PPS/FDs have described experiencing in the beginning of
consultations. The findings show that a common consultation initiator ‘How are you’ is
ambiguous and carries problems for patients with PPS/FDs. The fifth study was developing an actionable framework to provide clinicians the tools to use when wanting
to promote therapeutic alliance and reduce stigma in consultations for PPS/FDs.

Conclusions and Implications
Stigma can exacerbate negative patient experiences, contributing to a cycle of trauma,
and poor health outcomes. By employing clearer communication strategies and trauma-
informed care, it is likely that clinicians can mitigate these effects and foster more
positive patient-clinician interactions.