Objective:

To explore medical students’ experiences of stigma towards patients with Functional Neurologic Disorder (FND), particularly regarding stigmatizing language and behavior towards patients with FND, the impact of stigma on medical care of patients with FND, and approach to FND encouraged by students’ medical education.

Background:

FNDs are common and often disabling conditions characterized by neurological symptoms with rule-in signs that frequently demonstrate inconsistency.  Patients with FND report experiencing stigma in the health care setting, while physicians express a lack of understanding of FND. To reduce stigmatization, future physicians must be educated about FND.  

Design/Methods:

This was a single-center qualitative study of medical students at the end of their clinical training using semi-structured, focus-group interviews. Interviews were transcribed verbatim and independently coded by the three investigators. Using thematic analysis, investigators iteratively discussed and consolidated codes to reach consensus and define themes. After identifying similarities between proposed themes and Link and Phelan’s theory of stigma, the investigators used this theory as a sensitizing framework for further refinement of themes.  

Results:

Ten students participated across three focus group sessions. Themes included:

1. Detachment of health care professionals from patients with FND
2. Role of language in validating/invalidating patient experiences
3. Inadequacy of health care system for patients with FND
4. Tension surrounding discussions with and about patients with FND
5. Formulation of student understanding of FND through clinical experiences

Conclusions:

Themes illuminated project objectives while informing future theory development. Authors hypothesize that inadequate training and resources to manage FND leads to a feeling of helplessness among clinicians, causing them to respond negatively to patients and therefore role model negative interactions for students. Lack of education and resources for FND perpetuates stigma and poor care for FND patients.