Neurologists' approaches to making psychosocial attributions in patients with functional neurological symptoms

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Doctors perceive consultations with patients with functional neurological symptoms (FNS) as challenging because of the dichotomy between the psychosocial nature of the symptoms and patients’ perceptions that their condition is essentially physical. Through conversation analysis, we describe some communicative strategies neurologists employ to make psychosocial attributions, ranging from unilateral to more bilateral approaches. In unilateral approaches doctors employ general explanations about the psychosocial aetiology, thereby pre-empting any potential resistance. In bilateral approaches, doctors actively involve patients in discussing potential psychosocial causes, by also making direct and specific psychosocial attributions. These practices display doctors’ great caution in this communicative task; and they exhibit an hybridization with those employed by psychologists, which might be strictly linked to this type of patients.


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