Sunday, 14 June 2015

Emotions during MS consultations...Keep Calm.....I'm Italian!



Del Piccolo L, Pietrolongo E, Radice D, Tortorella C, Confalonieri P, Pugliatti M, Lugaresi A, Giordano A, Heesen C, Solari A; AutoMS Project.Patient Expression of Emotions and Neurologist Responses in First Multiple SclerosisConsultations. PLoS One. 2015;10(6):e0127734. doi: 10.1371/journal.pone.0127734. eCollection 2015

BACKGROUND:Anxiety and depression are common in people with multiple sclerosis (MS), but data on emotional communication during MS consultations are lacking. We assessed patient expressions of emotion and neurologist responses during first-ever MS consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).
METHODS: We applied VR-CoDES to recordings/transcripts of 88 outpatient consultations (10 neurologists, four MS Italian centres). Before consultation, patients completed the Hospital Anxiety and Depression Scale (HADS). Multilevel sequential analysis was performed on the number of cues/concerns expressed by patients, and the proportion of reduce space responses by neurologists.
RESULTS: Patients expressed 492 cues and 45 concerns (median 4 cues and 1 concern per consultation). The commonest cues were verbal hints of hidden worries (cue type b, 41%) and references to stressful life events (type d, 26%). Variables independently associated with number of cues/concerns were: anxiety; patient age neurologist age  and second opinion consultation . Neurologists reacted to patient emotions by reducing space (changing subject, taking no notice, giving medical advice) for 58% of cues and 76% of concerns. Anxiety was the only variable significantly associated with 'reduce space' responses
CONCLUSIONS:Patient emotional expressions varied widely, but VR-CoDES cues b and d were expressed most often. Patient anxiety was directly associated with emotional expressions; older age of patients and neurologists, and second opinion consultations were inversely associated with patient emotional expression. In over 50% of instances, neurologists responded to these expressions by reducing space, more so in anxious patients. These findings suggest that neurologists need to improve their skills in dealing with patient emotions.


The first sign is above the desk of one of our Italian Researchers
Here is  paper about VR-CODES


2 comments:

  1. The other issue with emotions is neuros sometimes run too quickly to use anxiety and or depression to explain symptoms
    I personally have had this issue, after having symptoms progress for 6 months but with relatively normal neuro exams with repeat brains and spine mri normal and normal lumbar puncture.
    The anxiety has increased as the symptoms have with no explanation but the neuros see it as the other way round. It's chicken and egg, anxiety will be there when your struggling for answers and facing a new disease

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  2. I have had such an awful time with NHS health care that I use part of my PIP money to pay for private health care now. I keep getting palmed off with seeing trainees for NHS appointments. Physiotherapist, neurology registrars, CBT therapists have been trainees. I know with private health care appointments are with consultants only and not trainees. It's all well and good to see trainees when there are hardly any issues/ problems and symptoms. But when it's more complicated it's not the best care. I know these trainees need to learn on the job, but it can be unfair on the patient. I slipped through the net on several occasions, once I was sent home and I should of been admitted as I was very very unwell. It was very frightening when I didn't know what was wrong with me at the time. Now I am an experienced MSer/expert patient it's fine to see some trainees as I can guide the appointments and I know what needs to be examined. So I can prompt the trainee. Should it really be this way??
    As a patient I have to be really on the ball, know quite a bit about neurology and medical knowledge.

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