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Chapter 7160may be questioned whether this reluctance is justified; in my own medical practice, I have spoken with patients, including Bob, who expressed a sense of relief when a practitioner finally mentioned the possibility of MID. This provided them insight into why they kept encountering a number of problems in their lives. In addition, participants in the patient-interview study expressed feelings of shame when they had to repeatedly admit that they did not understand the given information and preferred the practitioner to be aware of their MID and to take this automatically into consideration during consultations (Chapter 5). The struggles for both practitioners and patients in addressing a topic like MID are also evident in other sensitive issues, such as substance use, low literacy, and domestic violence. 7-9Practitioners often feel uncomfortable initiating a conversation about these issues; it is not a standard question in a consultation where the patient often has another reason for encounter, and practitioners have a lack of knowledge and experience on these issues and may not know how to address them neutrally. 8 Patients with MID themselves are also reluctant to bring up such sensitive issues, whether out of shame, lack of awareness of an underlying problem or of the impact of the issue on their health, or erroneously assume that the practitioner is aware of it. 7, 9 The use of open, non-judgmental questions within a trusted doctor–patient relationship is seen as helpful in addressing this sensitive issue. 7-9 It would be worthwhile to gain insight, through qualitative research, into the experiences and needs of patients when practitioners are addressing potential MID. This information could be used for the development of guidelines and practitioners’ training programmes that address this topic.Of course, the responsibility for early recognition of MID does not lie solely with GPs, but also with other care professionals in the GPs’ and patients’ networks, who may encounter these patients at an earlier stage or more often than a practitioner. This includes professionals in youth healthcare, the social domain, and MH services. It is also important for these professionals to be able to recognize signs of MID, to use screening tools, 10, 11 and to address the presumption of an MID with the person. Our research shows that, in MH services, patients’ MID often goes unnoticed. Given the high prevalence of MID among patients in MH services, it is recommended to routinely screen for MID during intake assessments (Chapter 4). 12 When Katrien Pouls sHL.indd 160 24-06-2024 16:26