Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions 2023 Begely

Abstract

Objectives
Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making.

Design/Methods
We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition.

Results
Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate—contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated with likelihood of referral to physical interventions such as physiotherapy. Medical doctors had lower treatment optimism and stronger explicit attitudes that FND is illegitimate than psychologists.

Conclusions
At an implicit level, clinicians are uncertain about the illegitimacy of FND, and such attitudes are associated with lower likelihood of referral to physiotherapy in particular. Improved education on FND among health care professionals is indicated.

Open access, https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12643

 

This debacle will be studied for centuries. How an entire profession of otherwise smart people can be so damn gullible and manipulable based on nothing but peer pressure and tradition, through a mindless process of constant repetition and affirmation of the con.

And the longer and deeper it goes, the worst the impact on the credibility of medicine. It creates an environment in which the emperor's missing clothes have to be praised endlessly, no one wants to be the first to admit they should have known better. The cost of admitting reality just grows higher and higher, even though all it would take to end this is if someone actually counted it all out. But innuendo and false promises are good enough evidence in medicine, once something has crept in places, it just sticks around like black mold.

Also: this is actual beliefs about illness.

 

In my opinion, the concept FND has no proof.

It's just another layer that muddies the waters around legtimate complex chronic diseases.

 

I only skimmed the article but it reads to me as regarding doctors' (i.e. non FND-promoting specialists) view of the concept of FND as an "illegitimate" explanation for the patients' symptoms. I don't think it is questioning the patients' symptom reporting.