Middle Eastern Journal of Disability Studies

fa چالش‌های تشخیص و درمان بیماران روان‌تنی از دیدگاه کادر پزشکی: مطالعه‌ای کیفی Challenges in the Diagnosis and Treatment of Psychosomatic Patients from the Perspective of Medical Staff: A Qualitative Study روانشناسی Psychology مقاله پژوهشی اصیل Original Research Article زمینه و هدف: اختلالات سایکوسوماتیک و علائم جسمانی پایدار از چالش‌برانگیزترین حوزه‌ها در نظام سلامت به‌شمار می‌رود که اغلب در مرز مبهم بین زیست پزشکی و مداخلات روان‌شناختی قرار می‌گیرد. پژوهش حاضر باهدف واکاوی تجربه و ادراک پزشکان از مواجهۀ بالینی با بیماران سایکوسوماتیک و تبیین فرایندهای مؤثر بر تضعیف یا شکل‌گیری اتحاد درمانی انجام شد. روش‌بررسی: این مطالعه با رویکرد کیفی و مبتنی‌بر نظریۀ داده‌بنیاد انجام شد. داده‌ها ازطریق مصاحبه‌های نیمه‌ساختاریافته با هشت پزشک دارای تخصص‌های مختلف گردآوری شد. تحلیل داده‌ها به‌صورت هم‌زمان با گردآوری و طی مراحل کدگذاری باز، محوری و انتخابی انجام شد و فرایند تحلیل تا دستیابی به اشباع نظری ادامه یافت. یافته‌ها: یافته‌ها به استخراج چهار محور اصلی انجامید: نارسایی‌های ساختاری نظام درمان؛ کنش‌های بالینی و ارتباطی ناکارآمد؛ فقدان همکاری بین‌رشته‌ای نهادینه‌شده؛ ابعاد هیجانی تجربه بالینی پزشکان. ادغام این محورها در مرحله کدگذاری انتخابی موجب شکل‌گیری مقوله هسته‌ای «فرایند تضعیف تدریجی اتحاد درمانی در بستر ناکارآمدی نظام درمان» شد. نتایج نشان داد، این عوامل در قالب چرخه‌ای پویا و خودتقویت‌کننده، به تضعیف اعتماد، فرسایش رابطۀ درمانی و بازتولید رنج بیماران سایکوسوماتیک منجر می‌شود. نتیجه‌گیری: براساس یافته‌های پژوهش، جسمانی‌سازی نه پدیده‌ای صرفاً فردمحور یا زیست‌پزشکی، بلکه حاصل برهم‌کنش چندسطحی عوامل ساختاری، رابطه‌ای و هیجانی در نظام درمان است. اصلاح مواجهه با بیماران سایکوسوماتیک مستلزم توجه هم‌زمان به سلامت روان و ظرفیت‌های هیجانی پزشکان، تقویت همکاری بین‌رشته‌ای و بازنگری در فرهنگ آموزش پزشکی است Background & Objectives: Psychosomatic disorders and persistent somatic symptoms are considered among the most challenging clinical areas in contemporary medicine, a domain in which the boundary between body and mind is constantly a site of contention, ambiguity, and reductionism. Psychosomatic patients frequently present with persistent physical symptoms that lack sufficient organic explanation, placing them at the intersection of medical and psychological care. Despite the high prevalence of such patients in clinical settings, the diagnosis and treatment of psychosomatic conditions remain challenging for healthcare systems. Previous research has predominantly focused on patients’ experiences, while the perspectives of medical staff—who function as the primary gatekeepers of diagnosis, referral, and treatment—have received comparatively limited attention. Understanding the challenges faced by medical professionals is essential for identifying systemic barriers and improving the quality of care for psychosomatic patients. Therefore, this qualitative study aimed to explore the challenges associated with the diagnosis and treatment of psychosomatic patients from the perspective of medical staff, with particular attention to structural, educational, emotional, and interprofessional factors within the healthcare system. Methods: A qualitative research design was employed using in–depth, semi–structured interviews with members of the medical staff, including physicians from various specialties involved in the care of psychosomatic patients. Participants were selected through purposive sampling to ensure diversity in professional roles, clinical experience, and areas of specialization. Data collection continued until theoretical saturation was achieved. Interviews were audio–recorded, transcribed verbatim, and analyzed using an inductive coding process consistent with grounded qualitative analysis. Open, axial, and selective coding were conducted iteratively, allowing categories and their relationships to emerge from the data. Trustworthiness was ensured through prolonged engagement with the data, peer debriefing, and reflexive memo writing. Results: Analysis of the interviews led to the identification of several interrelated categories that collectively illustrate a gradual erosion of the therapeutic alliance in the care of psychosomatic patients. One major category concerned the role of the healthcare system, characterized by delayed and non–systematic referral pathways, a lack of clear clinical algorithms for psychosomatic presentations, and a tendency toward prolonged biomedical interventions despite limited effectiveness. Participants reported that such structural shortcomings often left patients frustrated and mistrustful before meaningful psychological interventions were considered. A second category reflected clinical and communicative practices, including the use of non–specialized treatments, insufficient attention to medication side effects, and the inadvertent invalidation of patients’ lived experiences through reductionist or dismissive language. These practices were perceived by participants as contributing to patients’ loss of trust in medical care and resistance to further treatment. The third category highlighted the emotional dimensions of medical practice, particularly emotional exhaustion, feelings of clinical inefficacy, and defensive emotional distancing. Medical staff described repeated encounters with complex psychosomatic cases as emotionally demanding, often leading to burnout and a diminished capacity for empathy as a form of professional self–protection. Another salient category involved the gap between medical education and clinical reality. Participants emphasized that formal medical training often inadequately prepares clinicians to manage diagnostic uncertainty, emotional complexity, and mind–body interactions inherent in psychosomatic cases. As a result, physicians reported reliance on reductionist biomedical frameworks that fail to address the multifaceted nature of patients’ symptoms. Finally, the absence of institutionalized interprofessional collaboration emerged as a critical challenge. Participants described fragmented care, a lack of structured feedback following referrals, and insufficient shared language and trust among different medical and mental health disciplines. This lack of coordinated teamwork was perceived as reinforcing systemic inefficiencies and perpetuating suboptimal patient outcomes. Conclusion: Based on the research findings, somatization is not merely an individualistic or biomedical phenomenon, but rather the outcome of a multi–level interplay between structural, relational, and emotional factors within the healthcare system. Modifying the approach to patients with psychosomatic conditions necessitates simultaneous attention to the mental health and emotional capacities of physicians, fostering interdisciplinary collaboration, and revising the culture of medical education. سوماتیزیشن, اتحاد درمانی, پزشکان, نظریۀ داده‌بنیاد, نظام درمان Somatization, Therapeutic alliance, Physicians, Grounded theory, Healthcare system 19 0 http://jdisabilstud.org/browse.php?a_code=A-11-4109-2&slc_lang=fa&sid=1 Mahtab Norouzi مهتاب نوروزی mahtabnorouzi07@gmail.com 100319475328460069216 100319475328460069216 No Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran گروه روان‌شناسی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران Mehdi Reza Sarafraz مهدی رضا سرافراز Msarafraz@shirazu.ac.ir 100319475328460069217 100319475328460069217 Yes Department of Psychology, University of Shiraz, Shiraz, Iran گروه روان‌شناسی، دانشگاه شیراز، شیراز، ایران Mehdi Manouchehri مهدی منوچهری m.manouchehri@iautmu.ac.ir 100319475328460069218 100319475328460069218 No Department of Psychology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran گروه روان‌شناسی، واحد علوم پزشکی تهران، دانشگاه آزاد اسلامی، تهران، ایران