How to learn skilled communication in primary care MUS consultations: a focus group study, Houwen et al, 2021

In my experience, once a health problem has been dumped in the MUS dustbin nobody ever looks into the problem again if they can help it. MUS has effectively become a diagnosis in its own right.

 

That is the whole objective of it I think. Out of sight, out of mind, and out of money.

 

Out of sight and out of mind for physicians who are overworked or can't be arsed.

Out of money? No. These patients are a source of endless cash.

I'm put in mind of a myth I heard many times while working. Some guy who was absolutely brilliant. Indispensable. He could and would fix any problem no matter how difficult or complex. Then he went of on holidays or off sick one day and they discovered why. He made himself indispensable and could fix all the weird problems because he deliberately caused them in the first place.

These guys have gone one further. These patients can't be fixed because there's nothing wrong with them. They are a burden, they are wastes of space hoovering up the resources others really need.

However, there is a solution. The BPS crew can help "manage" them. They'll still hoover up huge amounts of resources but probably from a different budget and they'll be someone else's problem.

Meanwhile our pals make a fortune writing apps and so on and doing "stuff" that, at best, achieves nothing at all.

 

I wasn't really meaning patients' own money, but the fact that parking people into a medical black hole is how the powers that be manage to allocate minimal resources to them.

 

No, I understood you weren't referring to patients own money at point of contact, though it kinda is if they pay tax. MUS, IAPT and so are soaking up millions of public funds to keep patients in a "holding pattern". We are not talking minimal resources at all.

What's more it's only a matter of time when money starts to be diverted from other sources to feed this voracious, predatory machine.

 

My heart sinks every time I see a demand for more money for mental health patients as it seems to mean more going to treat imaginary mental health problems in people with diabetes and the like while th epoor people with true mental issues have less and less spent on them

Unfortunately, they are like con men. They convince the authorities it will save them a load of money then they spend a fortune and move on before they are caught out. It makes me think of the monorail episode of the Simpsons

 

To be fair, in the case of young adults particularly, psychologists attached to diabetic clinics can be very helpful to young adults.

An example of this is a young teen, especially female, fluctuating hormones makes management of Type 1 very difficult. It's an age where they want more independence and less interference. It's also an age where they want to go and experiment and have a few sneaky drinks with their mates.

Psychological support (done well) can help young adults negotiate the fine line between becoming more independent, managing the frustrations of life with diabetes and compliance with monitor etc. It can save many a trip to A&E, hospital stays and reduce risks of serious complications. One dept I was in contact with had 18 year olds who were going irreversibly blind for example.

However, I completely agree that there are many a clinic and patient group where they make naff all difference.

I think mental health services probably suffer most from this IAPT boom as vitally needed & underfunded services face further cuts. Those facing serious and long term, severe problems neglected in favour of a one size fits very few, superficial service.

 

Oh I did not mean the ones attached to diabetic clinics, I am sure they do a good job. I was specifically referring to the IAPT program which is expanding from MUS diagnoses to uncontested diseases and I should have made that clearer.

I have family members with mental health problems and I do not think any extra money will be going to help them sadly.

 

Are you absolutely shitting me?