Guidance for commissioners of services for people with medically unexplained symptoms - 2017

Sly Saint said:
Physicians' responses to patients' medically unexplained symptoms
Abstract
OBJECTIVE:
To understand how physicians communicate may contribute to the mistrust and poor clinical outcomes observed in patients who present with medically unexplained symptoms (MUS).

https://www.ncbi.nlm.nih.gov/pubmed/16554393
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Thanks for posting these, @Sly Saint. I just had a look at the abstract for this one, and its kind of interesting. This is what they did:
After providing informed consent, 100 primary care physicians in greater Rochester, New York, were visited by two unannounced covert standardized patients (actors, or SPs) portraying two chest pain roles: classic symptoms of gastroesophageal reflux disease (GERD) with nausea and insomnia (the GERD role) and poorly characterized chest pain with fatigue and dizziness (the MUS role). The visits were surreptitiously audiorecorded and analyzed using the Measure of Patient-Centered Communication (MPCC), which scores physicians on their exploration of the patients' experience of illness (component 1) and psychosocial context (component 2), and their attempts to find common ground on diagnosis and treatment (component 3).
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This is what they found:
In multivariate analyses, MUS visits yielded significantly lower scores on MPCC component 1 (p = .01). Subanalysis of component 1 scores showed that patients' symptoms were not explored as fully and that validation was less likely to be used in response to patient concerns in the MUS than in the GERD visits. Component 2 and component 3 were unchanged.
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This suggests that even from the first visit, these US doctors are judging - based on your symptom profile - whether you are worthy of validation or not.
 
Woolie said:
This suggests that even from the first visit, these US doctors are judging - based on your symptom profile - whether you are worthy of validation or not.
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Which is concerning for people who find it hard to describe symptoms. I wonder how many they fail to diagnose due to not asking and patients having normalized additional symptoms.
 
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Some great debate and excellent points, as usual.

Jonathan Edwards said:
I actually think this guidance will fall completely flat. No patients are going to want to be referred to a clinic for MUS. Moreover, no psychologists or OTs are going to want to work in a clinic for MUS. Visiting and working in an ME clinic at least gives some sort of sense of purpose.
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One would think. But sadly this is too optimistic.

Invisible Woman said:
To be honest not only are some people so uncritical, they will actively seek it out.
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Yes. This.

I am approaching 5 months spent living in an inpatient ‘neuropsychiatric’ rehab unit, where the BPS model is used to treat ‘functional’ disorders. Yes these terms are fancier than ‘Medically Unexplained Symptoms’ but the core principals are the same. Let me tell you, this MUS bandwagon has legs. It will go far. Patients here are delighted with their care, feel they are being taken very seriously at last, and are totally open to all the repressed trauma Freudian speculation. When I try to spark some debate about what goes on here, I am met with smirks, rolled eyes, and awkward silences. Patients and staff alike view me as a precocious kid with a ‘persecution complex’. If you start talking about NHS shortcuts, big pharma etc you’re just seen as a conspiracy theorist.

As for the staff, yes there will always be psychs, OTs and physios to fill these roles. Believe me. The therapy team here are 99% white, in their 20s, and even some internationals (Aussie, French). This place has a national reputation. These are hotshot psych grads, moving to the Big Smoke on what I assume is a comfortable wage, cutting their teeth on some serious psychobabble. It’s not bottom-of-the-heap work to them. Quite the opposite, they consider this cutting edge. They boast endlessly about their long waiting list and high success rates. All the outcome measures used are as subjective as it gets. We are constantly drenched with rhetoric of road-to-recovery, progress, rehab, goals, coming out of your comfort zone and blah blah blah. It’s re-education.

MUS clinics will not be the feature of a gritty exposé, hitting tabloid front pages. They will get away with it and dress it up as life-changing treatment like this place does. Very scary, and very worrying. Just think of the amount of undetected organic health problems being neglected. It’s like regression, like we’re going back in time, denying the existence of modern medicine.
 
Tab Hoarder said:
MUS clinics will not be the feature of a gritty exposé, hitting tabloid front pages. They will get away with it and dress it up as life-changing treatment like this place does. Very scary, and very worrying. Just think of the amount of undetected organic health problems being neglected. It’s like regression, like we’re going back in time, denying the existence of modern medicine.
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Interesting. I can well imagine the sort of place you refer to. But maybe this is the honeymoon phase when young enthusiasts buying to the concept. After five years, when MUS becomes a butt of jokes, maybe things will change. I used to work in a physical rehabilitation centre in north London like this around the time that 'rehabilitation medicine' became a new speciality. It was full of hyper enthusiastic physios and OTs and other therapists. Within five years it had shut. But maybe the point is that the wheel will continually be re-invented?
 
Jonathan Edwards said:
But maybe the point is that the wheel will continually be re-invented?
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Those who don't learn from history are doomed to repeat it. And I get the impression that UK universities are doing a very poor job of educating psychology students and even medical students about certain aspects of reality that they could be learning a lot from. Instead they are likely being taught about how utterly miraculous the mind is in doing all sorts of improbable things, and it's taking them a few years of spectacular failure in the real world to realize it was a bunch of bullshit.
 
@Tab Hoarder, thanks for your perspective - and welcome to the forum! (love your username, by the way :laugh:).

I have also encountered a lot of FND people who are very comfortable with certain aspects of the psychostuff. Its seems to be acceptable when dressed up in one of two ways:

1. In pseudoneural terms (e.g., 'the neural hardware is okay, but there's a problem with the software')
2. In terms of past trauma that wasn't their fault

I think for some people who actually did experience bad stuff in the past, there's some appeal in being able to say 'look what you did to me'. It gives their illness some sense of meaning I guess, and maybe its good to have someone to blame.

FND patients seem much less keen on psycho explanations that propose they themselves have psychological vulnerabilities (e.g., overly negative schemas, difficulty managing emotional conflict, being intensely anxious or introspective).

Unfortunately, theorists and practitioners in the FND area are wise to this and they present their explanations accordingly. This is actually quite misleading. I reviewed contemporary FND theories recently and they all propose that the patients have psychological vulnerabilities - any or all of the ones listed above. Obviously, they must do this, because the theories need to get around the huge problem that not all trauma victims etc., have FND.
 
Woolie said:
FND patients seem much less keen on psycho explanations that propose they themselves have psychological vulnerabilities (e.g., overly negative schemas, difficulty managing emotional conflict, being intensely anxious or introspective).
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PS Add to say I don't believe any of these things are the cause of FND either! I find those accusations objectionable too!
 
strategist said:
There actually are patients who find the whole MUS culture wonderful and want to learn how to cure illness with mental acrobatics.

The tragedy of illness can induce irrationality.
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I think we can see from the positive reviews to Suzanne O' Sullivan's awful book https://www.amazon.co.uk/Its-All-Yo...ll_reviews&filterByStar=positive&pageNumber=1 how patients can fall hook, line and sinker for this claptrap. It's not only medics/psychs here giving 5 star reviews, although a good few are. There are ordinary people who truly believe in the Psych School's mind-body explanation
 
Jonathan Edwards said:
After five years, when MUS becomes a butt of jokes, maybe things will change. I used to work in a physical rehabilitation centre in north London like this around the time that 'rehabilitation medicine' became a new speciality. It was full of hyper enthusiastic physios and OTs and other therapists. Within five years it had shut. But maybe the point is that the wheel will continually be re-invented?
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So we have to wait five years in the hope that this will all fizzle out? It'll be too late by then.

MUS/IAPT practitioners are being employed all over the country to reduce the number of GP consultations, drastically cut outpatient clinic lists, and now, it appears, to identify/label/treat people at A+E to effectively prevent them from accessing these emergency services too. https://www.staffnurse.com/jdp/liaison-psychologist-j3s53474h3my3yw3t87

And let's not forget that they are even targeting elderly patients now, those who have in the past been relatively shielded from this MUS rubbish - Hidden in plain sight - Age UK (pages 21 - 24).


I'm sorry to say this, but MUS isn't a transient health fad, it's a political agenda. It's unlikely to change unless/until people wake up and challenge the politics.
 
Tab Hoarder said:
Very scary, and very worrying. Just think of the amount of undetected organic health problems being neglected. It’s like regression, like we’re going back in time, denying the existence of modern medicine.
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That's my impression, too. Thanks for writing about your experience.
When can you leave that place?
 
Tab Hoarder said:
Some great debate and excellent points, as usual.



One would think. But sadly this is too optimistic.



Yes. This.

I am approaching 5 months spent living in an inpatient ‘neuropsychiatric’ rehab unit, where the BPS model is used to treat ‘functional’ disorders. Yes these terms are fancier than ‘Medically Unexplained Symptoms’ but the core principals are the same. Let me tell you, this MUS bandwagon has legs. It will go far. Patients here are delighted with their care, feel they are being taken very seriously at last, and are totally open to all the repressed trauma Freudian speculation. When I try to spark some debate about what goes on here, I am met with smirks, rolled eyes, and awkward silences. Patients and staff alike view me as a precocious kid with a ‘persecution complex’. If you start talking about NHS shortcuts, big pharma etc you’re just seen as a conspiracy theorist.

As for the staff, yes there will always be psychs, OTs and physios to fill these roles. Believe me. The therapy team here are 99% white, in their 20s, and even some internationals (Aussie, French). This place has a national reputation. These are hotshot psych grads, moving to the Big Smoke on what I assume is a comfortable wage, cutting their teeth on some serious psychobabble. It’s not bottom-of-the-heap work to them. Quite the opposite, they consider this cutting edge. They boast endlessly about their long waiting list and high success rates. All the outcome measures used are as subjective as it gets. We are constantly drenched with rhetoric of road-to-recovery, progress, rehab, goals, coming out of your comfort zone and blah blah blah. It’s re-education.

MUS clinics will not be the feature of a gritty exposé, hitting tabloid front pages. They will get away with it and dress it up as life-changing treatment like this place does. Very scary, and very worrying. Just think of the amount of undetected organic health problems being neglected. It’s like regression, like we’re going back in time, denying the existence of modern medicine.
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An excellent post from the frontline. May I have your permission @Tab Hoarder to copy this post to other forms of social media please? I'm conscious this is already a public forum but wouldn't wish to make use of your desperate situation in a cynical way or without your express permission.
 
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