Themes

Themes

1) Symptoms in clinical interaction and care

Researchers from various disciplines have looked at bodily sensations and symptoms from a range of perspectives, including self-care and health care seeking, access to health care, negotiations in clinical encounters, awareness campaigns and early diagnosis of cancer, medically unexplained symptoms, persistent somatic symptoms, dealing with symptoms in daily life, and many more.

When negotiating symptoms in consultations, patients and clinicians may contribute different versions and interpretations. Culturally mediated accounts of what a bodily sensation and a symptom is feed into the patients’ experiences and practices as well as into medical classifications and diagnostic processes. Patients with persistent somatic symptoms often experience stigma by health professionals, also regarding the patients’ symptom descriptions and choice of words. Consultations can be seen as co-constructed stories, shaped by voices representing different epistemologies and knowledge regimes. Negotiations about symptoms in the processes of diagnosis, treatment and rehabilitation may affect not only diagnostic decisions but also collaborative relationships. How can the epistemic gaps in clinical interaction be bridged? We invite researchers to critically discuss this and challenge existing positions on how to understand clinical encounters looking at symptoms as the core unit.

According to the International Classification of Primary Care (ICPC), names of symptoms can also be used as diagnoses in primary care encounters. However, to obtain sickness benefit and other patient rights, a more specific disease diagnosis is often prompted. How and when do symptoms become diagnoses? And how useful are specific diagnoses for patients and for clinicians, in the case of persistent somatic symptoms, e.g. functional disorders or functional somatic syndrome diagnoses? Some researchers go beyond discipline specific diagnoses, emphasizing patients’ health related functioning, or searching for common mechanisms underlying persistent somatic symptoms, and looking for effective approaches to treatment that transcend diagnostic borders. We welcome abstracts from researchers engaged in all these topics!

2) Symptoms and new technological infrastructures in biomedicine

The production of symptoms takes place in different arenas shaped by biomedical knowledge, technologies, organizational aspects and clinical practice. What patients are able to negotiate as legitimate symptoms is framed by their position in this context and the interface with a health system. Notably, developing technologies play a crucial role for the expansion and/or refinement and shaping of what we attend to as bodily sensations and symptoms. One important and recent development concerns the diffusion of ‘personalized medicine’ and adjacent developments such as the focus on PROMs, digital phenotyping, AI, and PatientsLikeMe websites. ‘Personalized medicine’ or ‘precision medicine’ made its entry into medicine from genomic science and combines genomics with lifestyle and environment to advocate for the individual as a unique human being and for tailoring health care. All the above phenomena work along similar intentions and all of them are based on structured, digital and computable data that requires input from patients or patients to be, such as wearables that inform ‘the quantified self’. At the same time, an increasing number of internet and APP-based treatments are offered as self-help for symptoms, e.g. psychoeducation and mindfulness training. We wish to invite presentations that explore these new infrastructures of health and ask: To what extent do they create renewed or different attention to symptoms and sensations? What symptoms are privileged and how do they impact diagnosis, care and treatment? What patients, social lives and social relations are constituted in the processes of e.g. precision medicine, and how is knowledge produced and how does it gain power, with what impact? How effective are e.g. internet-based treatments and who is able to use them with what result? We wish to challenge and address the role of developing paradigms of health to scrutinize their impact on the fashioning of symptoms in patients’ lives. We welcome abstracts from researchers engaged in these topics!

3) Symptoms in disease, health and life

The definition of symptoms is closely connected to an understanding of disease, of something indicating illness, ailment, disorder etc. This understanding is basic, legitimate and necessary in a clinical context and a starting point for diagnosis and adequate treatment. (SYMPTOMS-DISEASE).

However, in some situations symptoms are more arbitrary and ambiguous, and health and care systems work with symptoms towards an integration of disorder and wellness, almost redefining symptoms to be signs of health. This movement may be what characterizes the organization and management of health promotion in public health. (SYMPTOMS-HEALTH)

In rehabilitation, several patients are treated based on symptom diagnoses and not disease diagnoses and rehabilitation approaches work in different ways towards recovery and return to work. How and what can we learn from the concept of symptom within a rehab context? Do diagnoses impede wellness processes? Could symptoms indicate normality? May we talk about healthy symptoms? (SYMPTOMS-WELLNESS, NORMALITY)

Nonetheless, even such shifts maintain a focus on concepts such as health, disease and fitness. A medical focus that has long threatened to be overfocused. This is especially evident in discourses about medicalization, overdiagnosis and overtreatment. Maybe we therefore need also to rethink the concept of symptom, all the time symptoms concern expressions of life and lived life that not necessarily require a pathological determination (diagnosis). In this, we need to rely on the richness of language to support expressions of the lived experience of suffering, pain, asymmetry or imbalance. That is, events which do not always require that we invite the medical symptom to the center of the stage. We welcome abstracts from researchers engaged in all these topics!

4) Breath

Breathing is essential for life and connects us to the surrounding world. Exterior and interior spaces are constantly in exchange. Breath can also be interpreted as a spiritual connection. Etymologically, the words for breath, air and spirit overlap in many languages. Metaphorically, breath is the core of life. Breathing is highly influenced by emotional experiences. Thus, breathing is permeated with social, cultural and existential meanings.

Breathlessness is a condition we have all experienced, either as part of daily life during physical exercise, or as a symptom of disease. For many patients with lung or heart diseases or with obesity, the shortness of breath develops gradually, and many tend to attribute it to ageing, lack of exercise, or smoking, and adjust by reducing physical efforts. In relation to COVID-19 breathlessness has been a sign of both the disease and of long-Covid. The symptom of breathlessness, and the patients suffering from it, have been described as invisible. Smoking is a possible cause for most diseases leading to chronic breathlessness and is more prevalent in lower socioeconomic groups. The stigma associated with smoking might encourage people to hide their condition or its severity.

Only during sudden changes, for instance during exacerbations of asthma, COPD, or heart failure, people tend to visit a doctor and complain of their breathing problem. This means that the GP often needs to show a particular interest in the patient’s breathing if shortness of breath is to become a diagnostic clue. How could clinicians deal better with shortness of breath, when it is to be explained and discussed with patients?

There are epistemic gaps between clinical knowledge, a broader cultural understanding, and the personal experience of breathlessness. Even in Long-Covid people experience severe breathlessness despite negative objective findings on lung capacity. How is the experience of breathlessness colored by prior experience, beliefs and cultural influences, and how is lay understanding changed by clinical assessment? How can new approaches to understanding and managing breathlessness be developed? We welcome abstracts from researchers engaged in these topics!