Table 2 Parallels between the patient and registrar experience
Patient experience (based on the existing literature) [ [11],[12],[20],[37],[39],[64],[68]–[95]] | Registrar experience | Potential response to the patient | Potential response to the registrar (by the supervisor) | |
|---|---|---|---|---|
The consultation process | Feels chaotic because the doctor cannot offer me an organic cause for symptoms | Feels chaotic because I cannot identify a diagnosis and evidence-based guideline | Open communication and explanation about the process | Discussion around models of the consultation process |
Patterns of attention and avoidance | Emphasis on physical symptoms allows me to be “taken seriously”. | Missing an organic diagnosis would be a serious error: I must attend carefully to physical cues to avoid this risk | Accepting and attending to psychosocial issues | Encouraging empathic connection regardless of symptoms |
Illness explanatory frameworks | Cannot find an illness explanatory framework or explanatory frameworks are complex, chaotic or contradictory | Cannot find a disease explanatory framework or explanatory frameworks are complex, chaotic or contradictory | Sharing explanations beyond a disease model. May involve narratives and metaphors. | Sharing understanding through explicit and/or implicit models. May involve case studies and stories |
The battle for legitimacy | Perception that doctors become frustrated because I am not “getting better” | Uncertainty as to whether this is a good use of my time: am I just creating dependence? | Recognising and respecting the patient’s suffering and their right to care | Helping registrar to manage suffering in the absence of disease |
Interpersonal relationships | My suffering is not recognised by others | My efforts to help are not valued by others | Recognition and reassurance | Recognition and reassurance |