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I realise that this situation exists. Interestingly, I don't think I ever found myself in it except when NICE refused to let me use the drug I had proven to work! And that wasn't my decision. And for one or two patients I inherited who had become hooked on regular steroid injections that were...

(I am a professor of medicine.) I don't think electrophysiological tests are any use for the face. There are no electrophysiological abnormalities in ME/CFS or fibromyalgia that I am aware of. Electrical tests on limbs are chiefly of use to excuse other things - and their use is quite limited...

If you want to be openly derogatory about all doctors that's fine by me but as a doctor it doesn't ring true. Most doctors would like to do their best for people but they get fed up if people have unreasonable expectations associated with diagnoses that don't mean anything useful. Surely the...

Indeed. As far as I was concerned as a doctor all the decisions were made by the patient. I was just there to explain what was available. Why should patients have to share their decisions with health workers?

I am afraid this looks like window dressing to me. I have this awful vision of an ignorant health care worker offering a useless treatment explaining at length how they are going to be terribly nice and friendly and share the decision with me as long as I am terribly nice and friendly to them...

The irony is that 'fibromyalgia' really means, in medical language 'whingeing about pain when there is nothing really wrong, oops, I mean it's all biopsychosocial'. Unexplained pain is at least just unexplained pain. The more a doctor believe in fibromyalgia the more they don't believe it's...

'I was told that they don’t treat patients with fibromyalgia, like me, regardless of what they come in for.' I can guarantee that is not actually what was said. Does anyone actually believe those words were used?

I am of course very well aware of the problem of not being believed. But just as members read this article from the perspective of being the patient I read it from experience of being on the other end as well. (Yes, I too have been the unbelieved patient.) Everything I see in this article...

I see this from the point of view of the doctor. 'Fibromyalgia is a term used 100 times more frequently by some physicians than others. Prevalence rates vary from 8% down to 0.05%. Which basically means the term is meaningless. ME/CFS has a specific meaning and is clearly useful, even if there...

I am sorry but I actually think physios need to take their ethical responsibilities seriously like anyone else and admit that they have no role here. In a way I think it is condescending to suggest that it is OK for physios to 'get involved but gently' because after all they are only physios...

It could of course be to stand on a piece of paper and ....

I agree but I think it is important at this point to re-focus on the blockage with dealing with the Cochrane review. I don't think it is pressure from psychiatry or BPS in general. The people who don't want to see this review give a null recommendation are people like Glasziou, Guyatt, Gotzsche...

But that would never have happened because the idea of getting people to exercise to get them out of fatigue goes back much further - certainly to the Second World War and maybe the first. Richard Edwards was recommending exercise in the 1980s. I am not sure that GET was ever really much to do...

Yes, at least the wording of the discouragement to exercise is pretty sensible and it is heartening that the NICE draft is being taken note of.

But this is in the context of LongCovid. It would be interesting to know what would happen if all the LongCovid clinics went over just to referring for CBT. I suspect there would be quite a stink. And I am not sure what sort of behaviour the therapy would recommend?

My view on this has actually changed in a major way. The problem was never the psychiatrists. It was always the primary care physicians - who outnumber psychiatrists by about twenty to one I suspect. The psychiatrists simply found a way to sell bogus treatments to GPs. Cochrane was set up by GPs...

OK, so it is really essential that organisations like World Physio start putting out documents indicating that there is no evidence base for such a referral and making that clear to governments. Saying that rehab is a fundamental part of recovery is just dishonest and against peoples' best...

I am sure that is right. But if World Physio and the physio profession agreed that exercise is not relevant to LongCovid and got that message back to GPs and governments sharpish that might stop all the nonsense. My beef is that this document says 'be a bit careful when you exercising people'...

Who requires them to do that?

I think I am right in saying that this whole business has nothing to do with psychiatrists. That seems a complete misunderstanding of the battle. There are no psychiatrists as authors or on IAG are there? The battle is with people in Cochrane with a bias towards low tech treatments based in...