Finding your own way to manage patients with functional disorders, Emmanuel, 2021

Andy

Retired committee member
CFS is converted to chronic fatigue in the rest of the article.
There is a high prevalence of patients with medically unexplained symptoms (MUS) in primary and secondary care settings. Persistence of MUS is common, with a study based in secondary care identifying half of all referred patients having no clear diagnosis yet have an associated impaired quality of life.1 Beyond the personal costs to these patients with functional disorders, there is accompanying impaired work productivity (approximated at £14 billion in the UK) and increased healthcare costs (estimated £2.9 billion to the NHS).2 The irony is that the need for a multidisciplinary approach integrating physical and mental healthcare services has been established for some time, but has proved elusive in practice. The articles in this themed edition of Clinical Medicine are directed towards helping the clinician find their own style of managing these common presentations, recognising the multi-system nature of the problem and finding their own way of understanding this and communicating it with patients.
Open access, https://www.rcpjournals.org/content/clinmedicine/21/1/1

Table of contents for this "themed edition" can be seen here, https://www.rcpjournals.org/content/clinmedicine/21/1/
 
'Finding your own way to manage patients with functional disorders'
:laugh:
Why not? Once you throw any idea of evidence-based medicine away, you might as well make up anything that particularly appeals. Paper circles on the ground, healing crystals, relentless positivity, whatever.
 
The irony is that the need for a multidisciplinary approach integrating physical and mental healthcare services has been established for some time, but has proved elusive in practice
When the description of the problem also includes the cause of the problem. Also not ironic at all, it's actually pathetic to insist that the problem is only a matter of how to make it work in practice, rather than a completely delusional set of assumptions lacking any evidence.
helping the clinician find their own style
What is this? Jazz 101? Find your own style elsewhere, please and thank you. Do some cosplaying, I don't know.
 
CFS is converted to chronic fatigue in the rest of the article.

Open access, https://www.rcpjournals.org/content/clinmedicine/21/1/1

Table of contents for this "themed edition" can be seen here, https://www.rcpjournals.org/content/clinmedicine/21/1/

So this overview is from the editor-in-chief of the Royal College of Physicians educational journal aimed at trainees. God help us.

A while back I was a bit optimistic that the MUS story would do an Icarus-style crash through its inherent absurdity. It certainly does not look like it now. I guess the only positive thing is that people are getting more used to the idea that so much so-called authoritative information is bullshit.

Maybe it was always like this.
 
If ever there were a cop-out "diagnosis" it is MUS. I could take my car to the garage because it won't go into reverse, and they come back and say they could not find any physical cause for it. They come back and tell me it is a well recognised condition, Mechanically Unknown Snags. So they gave it a wash and polish because that is the recommended remedy. For some reason my car still won't go into reverse.
 
If ever there were a cop-out "diagnosis" it is MUS. I could take my car to the garage because it won't go into reverse, and they come back and say they could not find any physical cause for it. They come back and tell me it is a well recognised condition, Mechanically Unknown Snags. So they gave it a wash and polish because that is the recommended remedy. For some reason my car still won't go into reverse.

Yes, mechanically unknown snags seems the right diagnosis.
Moreover, more often than not once it has been washed down it will go into reverse nicely (at least for a week or two) so it clearly is the right treatment. and next time is won't go into reverse you are guaranteed to take it to another garage so they would never know.
 
Themed edition introduction said:
The first highlights the importance of identifying pathological health anxiety, which often takes that most precious of commodities, time.
Barry, you are just looking at things the wrong way. Cars spend 99.5% of the time going forward, so your car's lack of ability to reverse is not really of any consequence. You need to get rid of this tendency to backwards thinking, and focus on going forward.
 
Sorry, I can't help myself...
but Barry, I think if you focused less on what your car is not able to do and more on what it can, things would be better for you, and you wouldn't need to bother the mechanics so much. For example, some therapy to improve your ability to go around in circles could be useful. (Circling Better Therapy)
 
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Sorry, I can't help myself...
but Barry, I think if you focused less on what your car is not able to do and more on what it can, things would be better for you, and you wouldn't need to bother the mechanics so much. For example, some therapy to improve your ability to go around in circles could be useful.
You are so right! If I can train my car to turn in really tight circles (on the spot would be ideal) then I would have no need whatsoever for a reverse gear. U-turns so tight I'd end up going forwards where my behind had been moments before. And mechanics ... haaa ... who needs mechanical devices when, as the Moody Blues very profoundly said, thinking is the best way to travel (to hell with context, who needs it?).
 
A while back I was a bit optimistic that the MUS story would do an Icarus-style crash through its inherent absurdity. It certainly does not look like it now.
That anger you see in us? That's fear. We know what is coming if this isn't stopped. For everybody, not just us.

There seems no appeal to evidence, reasoning, or simple human decency, no matter how compelling, that is able to stop this malignant juggernaut. This has been the case from day one.

It is too baked into the current system of governance, it is far too convenient and important to that system to be allowed to fail. Those responsible for it are never going to admit what they have done, and will fight tooth and nail to prevent being held to account for it.

It is without doubt the greatest failure and catastrophe in modern medicine for at least the last 50 years, and it is not going to be fixed any time soon, not before many millions more lives have been sacrificed on the altar of psychobabble, expedience, and egos.

Whatever the outcome of NICE and Cochrane, it is not going to temper their madness one bit. If these guideline reviews don't go their way they will just ignore them, or bullshit their way around them and end up doing whatever they want to in the clinic anyway.
 
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Sean, that is so true. I a truly afraid for my family and all those people going blindly on ignoring this until it finally gets them. We are seeing that with longcovid, all these medical people who are on the other side of table.

Beyond the personal costs to these patients with functional disorders, there is accompanying impaired work productivity (approximated at £14 billion in the UK) and increased healthcare costs (estimated £2.9 billion to the NHS)

That statement could be made about any disease. The unspoken part of the sentence is "despite having no genuine illness" They know that their theories would be rejected if they expressed the clearly so they go for leaving an impression just like a newspaper headline.
 
So this overview is from the editor-in-chief of the Royal College of Physicians educational journal aimed at trainees.

"His research includes gut neurophysiology and the study of the aetiology and management of functional gastrointestinal disorders of the upper and lower gut. He was appointed as editor-in-chief of Clinical Medicine and Commentary, having served a similar role for 8 years at Frontline Gastroenterology."

https://www.rcpjournals.org/content/clinical-medicine-editorial-board
 
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