Integrated care model for patients with functional somatic symptom disorder ..., 2024, Röhricht

Dolphin

Dolphin

Senior Member (Voting Rights)
Now published, Integrated care model for patients with functional somatic symptom disorder – a co-produced stakeholder exploration with recommendations for best practice, open access, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11130-9

https://www.researchsquare.com/article/rs-3939984/v1

Integrated care model for patients with functional somatic symptom disorder – a co-produced
stakeholder exploration with recommendations for best practice

Frank Röhricht
East London NHS Foundation Trust
Carole Green
East London NHS Foundation Trust
Maria Filippidou
East London NHS Foundation Trust
Simon Lowe
Circle Bedfordshire Integrated Care MSK service
Nicola Power
East London NHS Foundation Trust
Sara Rassool
East London NHS Foundation Trust
Katherine Rothman
East London NHS Foundation Trust
Meera Shah
Cambridge University Hospitals NHS Foundation Trust
Nina Papadopoulos
East London NHS Foundation Trust

Research Article

Keywords: Functional disorders, Medically unexplained symptoms, Psychosomatic medicine,
Somatoform disorders, Somatic symptom disorder, Bodily distress disorder, Embodiment, Body oriented psychological therapy
Posted Date: February 13th, 2024
DOI: https://doi.org/10.21203/rs.3.rs-3939984/v1

Abstract

Background:

Functional somatic symptoms and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals’ understanding of the nature of the symptoms. New service models are urgently required to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy.

Method:

A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the expert advisory group and conclusions summarised as recommendations for best practice.

Conclusion:

We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient’s complaints and provide flexible access points to the care pathway.
 
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Bedfordshire Chronic Fatigue Syndrome (CFS) Service:

The CFS service of Bedfordshire Community Health Services provided specialist MDT care for patients with at least 4 months of chronic and significant fatigue, where the fatigue was persistent or relapsing and was present for at least 50% of the time (as per 2016 guidance). Patients presented with associated symptoms such as joint/muscle pain, reduced memory and concentration, and the fatigue was having substantial impact on daily activities. The small multidisciplinary team of psychologists, physiotherapists, and occupational therapist provided MDT assessment, collaborative diagnosis and treatment, using, self-management education, Graded Exercise Therapy, CBT and Occupational therapy inputs (service treatment has since changed to ‘Energy Management Principles’).
 
Impressive load of horseshit.

To begin with, I was curious what "integrated care" even means, and I was not disappointed:
There is no single definition or best practice model for integration. It can mean different things in different contexts, and it can take many forms.
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So it's just a buzzword without an actual meaning. Because of course it is.
The paper said:
New service models are urgently required to address patients’ needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy.
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We propose a novel, integrated care pathway for patients with ‘functional somatic disorder’, which delivers care according to and working with patients’ explanatory beliefs
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Besides not being novel, there is no "overcoming" the dichotomy when it's the entire basis of the ideology, when it's about beliefs. Not our beliefs, theirs. I have no beliefs about my illness. The premise of this is silly and disrespectful.

From the looks of it, they asked what people doing psychosomatic services are doing, and build around that. So it's the same old, presented as novel, as is tradition. Bottle of piss v194.37.

They talk about honesty and transparent communication, but the entire basis of the ideology is to lie and make stuff up, in order to get patients to accept what they won't accept when it's honestly explained, because it makes no sense. So that means more lies, and more lying about lying. As is tradition. You can't lie to people and expect them to trust you. That's completely asinine.

Still trying to polish the same old turd. At this point it's been polished so much that it's reached Plank scale. But they're still polishing it anyway.

Just pure derivative copy-paste of the same old horseshit:
Subject to added expertise and resources, those service models might extend to other specific diagnostic groups such as ‘Chronic Fatigue Syndrome’ and ‘Functional Neurological Disorders’ as well as to some extend also ‘Long-Covid’ conditions as they pose significant challenges to health care providers given the diagnostic and aetiological uncertainty. The body-oriented nature of the novel primary care pathway can be an important enabler in lowering the threshold for patients’ acceptance of a holistic care offer, because it does not imply psychological causality in the same way as the IAPT/talking therapy model. Instead, an embodied therapeutic experience of contextualising symptoms, exploring their situational nature and the way body and mind operate, as a holistic organism, can also become an enabler for subsequent psychotherapeutic exploration of more specific aetiological factors.
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They just think we're dumb and one day will be fooled by the keys being jiggled in front of our face. It never worked, and they admit to that, but they base every 'novel' thing on the fact that they've been doing that successfully for a long time. Just spit-in-your-face disrespect for basic facts and attachment to reality.
 
Honestly, even astrologers aren't as repetitive and generic. What a dumpster fire.

Here are the main recommendations, and they are impossible to achieve:
  1. Transparent communication, accountability and coproduction
  2. The importance of primary care services and empathic/trustful communication for the patient journey and experience
  3. Updating knowledge through continuous professional development
  4. Systemic issues/the provider collaborative (whatever the hell that means)
  5. Treatment and support options
Frankly, none of those things are recommendations or amount to anything. The first 2 are absurd, there is no way to do this on the basis of lies, and the entire ideology has been obsessed for decades trying to find the best ways to lie to patients, and obviously have not succeeded at it.

The rest is just not going to happen, because MDs know what the lies actually mean, and can't care about nonsense.

I mean just look at this useless crap:
Based upon a clearly communicated working diagnosis, treatment should be offered according to the principles of informed choices, acknowledging that patients have different preferences and characteristics that impact the effectiveness of treatment options. According to the findings of this study, treatment options included in a portfolio for an integrated service, delivered by a multidisciplinary group of health care professionals and for patient’s choice: self-help (sensible literature web sites, handouts); problem solving for social/interpersonal problems; psychoeducation; reattribution approaches, psychological treatment: CBT, psychodynamic psychotherapy, mindfulness/mindfulness-based stress reduction, body-oriented psychological therapy, exercising; progressive muscle relaxation and related techniques; Yoga/Pilates courses; and drug treatments: herbal remedies and antidepressants.
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Always novel. Always the same. Always useless and ineffective. It's "informed choices", but patients don't have any choice, aren't informed, and neither are the clinicians. Just a complete clusterfuck of nonsense, lies and more lies.

I'm not even sure if blatantly politicized pseudoscience, say like Lysenkoism or some royal astrologer, where everyone involved understands it's all BS but don't have a choice to participate, was ever this silly and useless.

And really, it's all just the same crap in loops:
Subject to added expertise and resources, those service models might extend to other specific diagnostic groups, such as ‘Chronic Fatigue Syndrome’ and ‘Functional Neurological Disorders’, as well as, to some extent, ‘Long-Covid’ conditions, as they pose significant challenges to health care providers given the diagnostic and aetiological uncertainty. The body-oriented nature of the novel primary care pathway can be an important way to lower the threshold for patients’ acceptance of a holistic care offer because it does not imply psychological causality in the same way as the IAPT/talking therapy model.
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"Hey, I have an idea, what about we basically try to fool them into thinking we're not saying it's psychological? Did we try that? Oh we did? It's the current standard? Well, I have an idea: let's do it again!"

As usual the patient participants were completely tokenistic, their input was simply ignored and the traditional conclusions were simply, yet again, framed as having been co-produced. As is tradition.

Whether Einstein said it or not, the saying of the definition of insanity being trying the same thing and expecting different results really should clue in more people about this. The fact that it obviously doesn't is simply disastrous for the validity of the entire concept of expertise in human health. This is just pure ignorance and nonsense.

Edit: except, actually, no, they're not even expecting different results, they're expecting the same results, they just can't accept that they're wrong, and that is a whole higher layer of insanity.
 
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The importance of... empathic... communication

You can't teach empathy.

According to the findings of this study, treatment options included in a portfolio for an integrated service, delivered by a multidisciplinary group of health care professionals and for patient’s choice: self-help (sensible literature web sites, handouts); problem solving for social/interpersonal problems; psychoeducation; reattribution approaches, psychological treatment: CBT, psychodynamic psychotherapy, mindfulness/mindfulness-based stress reduction, body-oriented psychological therapy, exercising; progressive muscle relaxation and related techniques; Yoga/Pilates courses; and drug treatments: herbal remedies and antidepressants.

Nor shame, apparently.

I don't see effective treatment among the choices.
 
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