It looks to me like they are trying to put even more illnesses into the MUS category:
"On average, 52% of patients accessing outpatient services have MUS, with the highest rates relating to gynaecology clinics (66%) and the lowest rate (37%) relating to dental service"
"The risks or associated factors for MUS include being female, younger in age, and currently employed" - actually the table they use to show the breakdown of MUS referrals in outpatient clinics says 57% women, 42% men - I don't think that is statistically in favour of being female?
" MUS may be caused by physiological disturbance, emotional problems or pathological conditions which have not yet been diagnosed .... In severe cases of MUS, there is overlap with personality disorder...Consequently, many people with MUS have complex presentations caused or exacerbated by co-morbid mental health problems such as anxiety, depression or personality disorders...There should be a positive emphasis on ‘function’, rather than a focus on ‘cure’"
these were all from page 6
Page 7 - the internet is bad! "However, quite often misinformation and inaccurate advice, provided either by health professionals or other sources patients have accessed, such as the internet, can make it difficult for doctors to know what to do in cases of MUS."
While they do mention physical disorders they are normally in conjunction with co-morbid psychological ones.
This looks to me to be a type of bridging paper which introduces even more areas (Dentistry, Respiratory, Rheumatology, Gynaecology, Neurology, Gastroenterology, Cardiology) to the MUS bucket. There is a case study on using psychotherapy for MUS conditions without mentioning which ones. Then making it seem that using psychotherapy led to cost savings -
"Detailed information on health service use was collected for a sample of 282 patients treated by the PCPCS. Based on this data, it is estimated that treatment by the PCPCS reduced the costs of NHS service use by £463 per patient in the 22 months following the start of treatment. Savings in primary care accounted for 34% of this total (mainly fewer GP consultations) and savings in secondary care for 66% (fewer A&E and outpatient attendances and inpatient stays)."
In the perfect setting it recommends
- "biopsychosocial assessment and treatment on wards and in dedicated MUS outpatient clinics.... The hospital MUS service will redirect patients from the emergency department, expedite discharges from medical and surgical wards, and offer effective interventions. These activities should help avoid unnecessary medical investigations and interventions, reduce length of hospital stays, and prevent frequent referrals and readmission"
It is actually a really scary document that seems to be a five year plan to get MUS services (provided by specially trained people!) integrated into the NHS to help reduce A&E admissions etc and take away the burden from the local authorities. It relates all of this to mental health.
It talks about special clinics etc and using biopsychosocial methods - I wonder who would need to be engaged to provide this, and how much money would be needed for their services!!
