Effectiveness of a symptom-clinic intervention ... multiple and persistent physical symptoms, 2024, Burton, Deary et al

Hutan said:
There are different versions of the PGIC. I don't understand how any scientist could look at the version these authors used (the version above) that so obviously minimises declining health and any harm from the intervention and has vague, difficult to differentiate descriptions and think that it was ok to use. It suggests that all of the literature using the PGIC is suspect until proven otherwise.
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It makes sense when we just believe that when they say they think there is nothing wrong with our bodies, that's what they mean. It's like telling a child that they know there is no monster under the bed, you just checked and it's safe to sleep.

No matter how they try to frame it as "yes, but believing in a monster can truly bring symptoms" makes no difference to the fact that in this scenario, there are never monsters under the bed. Straight up never have, never will be. They know what they're doing, they're just basically executing code that falls within a if(false) statement.

It's all completely monstrous, pun intended, but it makes sense as long as you agree with a premise that is false. This is the nature of beliefs, why they can be so dangerous, why they usually hurt others far more than they hurt the believers themselves. It's their beliefs that makes this all so harmful, but the nature of beliefs makes the believers unaware of it, to them it's just logical, rational, common sense, it's not just true, it's Truth.
 
rvallee said:
makes no difference to the fact that in this scenario, there are never monsters under the bed.
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Yes. Except of course when there are.

from Supplementary Table 11

Total serious adverse events: 5 in the care as usual group; 12 in the intervention group

Cancer (1 person in the intervention group)
"Asymptomatic cancer detected through routine screening programme."

Serious medical condition (2 people in the intervention group)
Not specified

Suicide event (1 person in the care as usual group)

Other severe adverse events (4 people (4 events) in the care as usual group; 6 people (9 events) in the intervention group)
"Serious adverse events recorded as ‘other’ included two overnight hospital stays with unrecorded reasons, two cyst removals, one ectopic pregnancy, one seizure, one patient experiencing chest pain, one with abdominal pain, one depressive episode, one suspected blood clot, one urinary tract infection, one stroke and one suspected stroke."
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Ectopic pregnancy, stroke.... If these people were in the 'all these symptoms, they are just your brain being a bit over-sensitive, dear, don't worry so much' group, imagine how much harder it was for them to get timely treatment.

'one urinary tract infection' - a urinary tract infection is not a severe adverse event unless it is allowed to become so through lack of timely medical care.

Ugh, these people with their patronising certainty.
 
Just to confirm, the Fryer et al. paper does outline in much more detail what the intervention involved, by way of describing the training of the 5 GPs who gave the intervention to patients in the Burton trial.

The following section describes what techniques were taught to patients:
3.3.3. Action
In their training, GPs were given specific breathing, relaxation, and sensory grounding techniques to suggest to and teach the patients. The training also covered increasing activities, finding information, social support, and dealing with the medical profession. In supervision, further techniques were rehearsed and then implemented including activity, rest and sleep management, simple grief work, mindfulness, anxiety and mood management techniques. Clinic GPs were provided with study-specific leaflets outlining these techniques which could be shared with the patient.

The breathing and relaxation techniques were the most common suggestions made in the consultations.
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It's such a shame that this is being used as a way to avoid further tests and diagnosis, rather than as a way to help patients cope either while they wait for those things, or in the situation where there genuinely isn't anything else the medical profession can offer.
 
Lucibee said:
Just to confirm, the Fryer et al. paper does outline in much more detail what the intervention involved, by way of describing the training of the 5 GPs who gave the intervention to patients in the Burton trial.

The following section describes what techniques were taught to patients:


It's such a shame that this is being used as a way to avoid further tests and diagnosis, rather than as a way to help patients cope either while they wait for those things, or in the situation where there genuinely isn't anything else the medical profession can offer.
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It seems like a mind-boggling expensive way of teaching someone to relax and breathe ;)

One session with an OT would be as helpful (for those patients who didn't feel patronised....).

And only after a medical professional has levelled with them honestly to simply state, 'we dunno' what is causing your symptoms, we sadly currently have no effect treatments and in the meantime looking after yourself and so forth is the best that can be done.... And patients are unlikely to stop seeking tests and so forth until they believe that all possible treatable issues have been assessed. So by trying via opaque methods to essentially persuade a patient to do x or y, I suspect in time they are perhaps more likely to seek further medical input and be less trusting of doctors.
 
Letter in the Lancet by David Tuller & Joan Crawford, with a reply from the authors:
Christopher Burton and colleagues1 conducted an unblinded trial of a consultative intervention for 354 people with persistent physical symptoms but no identifiable “organic” cause. Patient Health Questionnaire-15 (PHQ15) score, which is a brief, subjective, self-administered screen of severity of somatic complaints, was the primary outcome. This kind of trial design can be expected to produce modest positive outcomes, via expectation bias alone.2 No real-life, objective assessment of functioning was conducted.

The intervention involved up to four sessions with a general practitioner, offering patients “rational explanations” for their symptoms in the absence of known, falsifiable causes and helping patients to develop strategies for managing symptoms. Although the “rational explanations” are not described, they presumably did not include “organic” diseases or conditions.

Scores on the PHQ-15 range from 0 to 30. Recruited patients had scores from 10 to 20, indicating moderate severity. At the end of the study, the adjusted between-group difference of –1·82 did not reach the minimal clinically important difference of 2·3.3 The change is well within what would be expected from bias alone. The results therefore confirmed that the intervention was of limited, if any, practical benefit. However, the paper presents the findings as though they had shown the opposite.

Instead of the “rational explanations” promoted by the investigators, more straightforward and honest explanations—for example, we do not know what is causing symptoms—could easily have produced similar results. Patients desire resolution of symptoms and recovery of functions. The trial did not achieve this result. Postintervention, participants continue to have an impaired quality of life and poor experiences of health care.
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https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(25)00329-0.pdf
 
Authors' response said:
Encouraging health professionals to proclaim “we do not know what is causing symptoms” in response to persistent physical symptoms, as Crawford and Tuller recommend, underestimates the explanatory power of recent symptom science and is likely to perpetuate the frustration and hopelessness of both clinicians and patients, which is all too common in this field.
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They are too insulated in their ideological bubble. If they ever listened to patients, just once, they'd easily know that we want real explanations, not fake-but-hopeful ones. And this has nothing to do with some obviously perfectionist demand over perfect knowledge. There are very few diseases that have perfect knowledge. What we need is good enough knowledge, and their stuff isn't it at all.

Patient forums are filled with frustration at this very thing, begging physicians, in frustration, to admit when they don't know something, how fake explanations are self-defeating because it obviously encourages them to stop looking. It makes them lose respect in physicians, in medicine itself. They can easily know this, and they probably do. But they still prefer to hold on to their fantasies.

This is a "let them eat cake" justification, one that completely ignores the issues raised in the comment. Awful. I don't even know why editors accepted the non-answer, it completely ignored what was said.
 
Encouraging health professionals to proclaim “we do not know what is causing symptoms” in response to persistent physical symptoms, as Crawford and Tuller recommend, underestimates the explanatory power of recent symptom science and is likely to perpetuate the frustration and hopelessness of both clinicians and patients, which is all too common in this field.

The frustration and hopelessness of clinicians is largely due to their own incompetence.
That also leads to frustration and incompetence on the part of the patients.

The crux of that incompetence is the inability to recognise its existence.
 
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