title: Electronic Support Groups: An Open Line of Communication in Contested Illness.
abstract: Patients with functional somatic syndromes are often difficult to treat. The relationship between doctors and patients can be strained, which limits communication. Instead, patients often communicate with each other over the Internet in electronic support groups.
  
  
  
  This perspective summarizes studies of patient-to-patient communication over the Internet and uses the concept of contested illness to provide insights into the experiences of patients with functional somatic disorders.
  
  
  
  Conflict between a patient and their physician is a key feature of functional somatic syndromes. Physicians and patients do not have a shared understanding or appreciation of the patient's experiences. Patients with functional somatic syndromes often value their own embodied experience over medical knowledge. At the same time, they remain deeply invested in finding a "good doctor" who believes that the patient is suffering, agrees with their conception of the cause, and assents to the treatment as directed by the patient. Electronic support groups reinforce these beliefs.
  
  
  
  Patients may benefit from a compromising, collaborative approach that is realistic about the limitations of medical knowledge. However, physicians should not engage in unsafe treatment practices. Electronic support groups exist for a wide range of illnesses and the issues that rise to the surface in functional somatic syndromes likely occur to some extent with almost every patient.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA; McLean Hospital, Belmont, MA. Electronic address: mmurphy56@partners.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kontos
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Oliver
authors.initials: O
authors.lastname: Freudenreich
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D020407:Internet; D010817:Physician-Patient Relations; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012657:Self-Help Groups
keywords: Consultation-Liaison psychiatry; health; internal medicine; quality of life; somatization