Is it true that more than half of medical consultations are for MUS? A look at the evidence.

I feel I have to say it, since it's claimed several times in this thread: No, I don't feel like that. Certainly, there are people that interact with me on eye-level, but there also people who don't. Just with regards to me, because I can't speak for others, I don't feel this is generally true.

 

That's what I've just wanted to write: That's how I understood it.

On top of that, it's quite realistic the MUS numbers aren't correct - but it is assumed they are by some people, including institutional settings.

 

If you write about any industry long enough, whether or not it be medical, you will use rule-of-thumb numbers. It's a short hand. It doesn't make those numbers right. I use them all the time with Lyme when I reference 20% of those infected do not get well despite abx. I am fully cognizant that there are those who dispute those numbers - both ways. But those numbers ARE widely acknowledged.

Nevertheless, there are vehement protests against those numbers, and maybe with good cause.

I think clearly that is all that is going on here. I do not blame @Diane O'Leary for indulging in that tool.

 

Yes, much like the 250,000 with ME that seems to have been the " go - to " figure for a long, long time in UK.

 

I think the problem is that we don't have any reason to say that. I don't think even any of the papers counting proportions of 'MUS' (in capitals implying the author assumes a psychological origin) say this.

I am not saying that you are writing as if 50% were psychosomatic. I am puzzled that you use these figures for unexplained symptoms, assuming that are not psychosomatic.

You are describing what I would call 'mus' (in small letters meaning that it is read literally, not as a term of psychosomatic art). But there is no reason to think the numbers for MUS equate to numbers for mus because all the papers ascertaining proportions for MUS build criteria relating to psychosomatic attribution into the counting. MUS does not mean any mus. It means symptoms in people who repeatedly attend doctors for multiple different complaints and because of this behaviour are specifically deduced to have a psychological problem. The situation is complicated by the fact that the papers quoted may well disingenuously add up all examples of mus they can find despite claiming that they are only counted if they fit criteria for MUS. But these figures are specifically intended to imply psychological cause. Their authors would not want them to be used for non-psychological mus.

I guess the point is that if we all agree that these figures are not credible for MUS then we have already assumed that they are pretty meaningless and so we would not want to make use of them as numbers for mus. As indicated above, mus occur in 100% of us. So what? The problem is not the mishandling of mus. The problem is the mishandling of people who for whatever reason attend doctors repeatedly with multiple complaints.

 

Ah, I see now. The reason that Up to Date states "over 50% of patients are not suffering from a medical condition" is that this has been received opinion for decades, particularly in health policy. There is a ton of research over many decades that established this picture. Try looking up Barsky in the 1980s. (That stuff will really make your hair stand on end.)

In my opinion it's not possible to dispute this picture by quoting research. It's too entrenched, and there are literally thousands of papers that support it. In any case, it's actually useful for the ME cause to accept that half of symptoms are undiagnosed. It shows that half of the time doctors don't actually have answers. Then it's easy to show that there's never been a safe, scientific approach to handling that reality.

Unexplained symptoms actually are extremely expensive for the health system. It's good for the ME cause to acknowledge that too - because it helps us show that ME management is not based on what's good for patients. It's based on what's good for the budget.

 

I have to go to work now, but quickly - you are so right that there's conflation of proportion of symptoms and proportion of patients. And you're right about how important this is to the statistical picture! The research on this stuff is so bad that they have not reckoned with this problem. That's what I'm saying. You're not going to find an answer to this question in research because they're not that careful. It's appalling. Very deeply confused on so many levels. That's a big part of what I do - I show all the ways that this stuff is unscientific.

Sorry, it takes time to hunt down that paper and find the passage you're looking for, and I have to get back to work. Anyway, suppose we could show that paper to be deeply faulty, what then? Nothing, because there are thousands more where that came from. Up to Date doesn't pick this stuff out of the sky, and they don't base it on one paper. Research has supported this picture for decades.

 

Yep, point accepted, @Inara. I can only say so for myself.

_________
This statement I find worrysome:

Could you please explain, @Diane O'Leary, what you mean with "you good people" [in contrast to whom?] to "are very trusting" [into what?] to "I think you don't know what xyz in professional discourse looks like" [why not?].

Thanks.

________

 

Maybe because most people here haven't presented their findings on conferences and witnessed the shark tanks there? There are some "buzz words" with a certain meaning. Also, my experiences were questions weren't asked out of interest and the desire to understand, but to show how incompetent someone was. It was pure competition.

 

I'm not sure if the data informing policy being valid is relevant.

As a completely uninformed and unqualified outsider it looks to me as if policy is decided, then data generated and/or manipulated to fit the policy. For PR purposes only. The intent is never to help people, to solve a problem, the intent is to achieve whatever political objective the policy was designed to, whilst also, if possible, looking like they 'care'.

So expecting any data to fit with the stated objectives, as opposed to the actual objectives, seems to miss the point, at least to me.

I suspect this is why it's so hard to refute some studies, some people, because nothing we say, no objections we raise, are, in any way, relevant to them. Because the studies, the people, weren't ever intended to help anyone, and pretty much everyone involved, from academics, to government, knows that.

 

I mean, genuinely, that the people on s4me are good, well meaning people. You're also highly intelligent, articulate and very well informed.

 

Medical records in the NHS are dreadful. Doctors will lie if telling the truth will put them in a bad light. If they get something wrong they tend to make it disappear. As a 13-year-old I had a very serious medical issue that is (nowadays) described as a medical emergency. I was in extreme pain for a month before I was finally referred to hospital. My medical notes record that I was in pain for 24 hours. The explanation for the problem I had has been hidden away and watered down.

 

I had seen that opinion a few times and thought it was a fringe idea. Seems it's a common belief that influences practice. That really explains a lot.

I really can't follow the thought process, it does not follow any rational logic beyond the god of the gaps or some other logical fallacy. It makes intuitive, superficial, sense but that's not something a professional should be fooled by. That kind of thinking basically amounts to recording unsolved crimes as "no crime occured". It's not just an inability to differentiate, it distorts the data entirely.

Plus as has been discussed it does not differentiate between patients and symptoms. Most patients with difficult to diagnose conditions will have seen 10-20 physicians, all of whom will have concluded "no medical condition" as a temporary status. But there is no back-propagation to mark those consults, they remain false negatives that leave the impression that 9-19 or so patients were incorrectly found to not have a medical condition.

This is really like getting old enough to understand that not a single adult actually knows what they're doing. That's usually not so bad, but when it's coupled with a mentality that refuses to acknowledges mistakes or fallibility in a life and death profession, well, people suffer and die. Serious, major, reforms are badly needed.

 

Perhaps a sign of getting older is the realisation as to just how much of life is determined by people " winging it" .

 

Except for when the BPS crowd tried to inflate that figure to 600,000 in 2013.
It was only when it was repeatedly questioned where that figure came from that they dropped it.
Always empire building.
Here's Bristol University's press release quoting the figure on behalf of Crawley.

https://www.bristol.ac.uk/news/2013/9741.html