Management of medically unexplained symptoms in children and young people: a secondary analysis of a 10-year audit... 2024 Colville et al

Full title: Management of medically unexplained symptoms in children and young people: a secondary analysis of a 10-year audit of referrals to a Paediatric Psychology Service

Abstract

This study evaluated service use of children and young people with medically unexplained symptoms (MUS) referred to a Paediatric Psychology Service between 2008 and 2017. Univariate analyses of activity data indicated that the MUS group (n=268) required more clinical sessions than other patients (n=3577) (inpatient MUS: 7.5 (12.5) vs general: 4.0 (6.0), p=0.006; outpatient: MUS 10.7 (15.0) vs general 6.3 (8.9), p<0.001). Multivariate analyses confirmed that MUS group status remained significantly associated (p<0.001) with a higher number of contacts, even when age and gender were controlled for. Although both groups benefitted equally from psychological input, MUS referrals required more contact time than general referrals.

Open access, https://bmjpaedsopen.bmj.com/content/8/1/e002765

 

As a quick read it seems that this psych support is the only ‘treatment’ MUS get. 268 of them from paediatric and neuro compared to 30,000+ ‘other’

so I’m guessing it isn’t like fir like in severity of need. It’s an adjunct gif all the rest. And symptoms like seizures listed so no idea of the level of severity of this small cohort chosen vs what level triggers referral for the rest.

They say they need twice the appointments but ‘respond equally well’ but if it was a treatment for the condition shouldn’t that be ‘better than’ - rather positive rephrasing to me. But is it the same ‘treatment’? We know Mus often gets gaslighting flase beliefs crap instead of CBT to cope with having x illness with real beliefs. Ie are being brainwashed to think they don’t deserve and into the beliefs of HCPs that whatever symptoms they have don’t exist.

But they need twice the appointments - well they aren’t getting anything elsewhere and are probably very confused by that lack of medical care. but also there are no clinics like the other patients giving them management tips adjustment, letters, treatment. So why would twice the appointments be weird.

I find it so sad to think that maybe secretly this isn’t sympathetic stuff at all but shove off kids before they’ve been fully looked into , and provide them with a label that prevents them from asking for more and weakens their ability to highlight things getting worse without huge threats like Fii accusations

so is the CBT to make them understand their role in that dystopia and how to be a good little problem that shuts up else worse will happen so best to gaslight yourself you aren’t an ill person and just hope the HCPs aren’t wrong ?


I have such concerns about this Mus culture. It feels like a mechanism used by an institution and an awful one that is all controlling coercion and potential threats if you insist on not appearing healed that it could be a living nightmare


Meanwhile those being part of this weaponising are focusing on funding for how many sessions not whether even what they do really harms their wellbeing vs forces them to appear to perform or behave better whilst destroying their psyche

 

Out of curiosity is this something / a ‘management technique’ that is more prevalent in societies with eg socialised medicine , particularly like the nhs who seem to have started with x promise years ago and there is a lot of behind closed doors back-rolling to try and now ‘not cover x y z ‘ whilst politically still seem to

I don’t know whether even countries like the USA have enough backstops for those poorer this would be an issue or if there are limits on what insurers can charge so it comes from them (in Uk I’ve heard the can just use nudges so if you had expensive treatment for more than a year you’d be covered that year then struggle to renew)

- I’m not sure MUS is actually that expensive though , this whole thing is like some invented phantom that can be whatever anyone wants it to be

and is very convenient to the political habit of covering up or fixing issues they know are caused by other things with an excuse and a spiel tgat just keeps making that dumping pots lot so much worse

but as it isn’t causing anything never fixes the claimed problem so keeps ratcheting

I feel heartbroken kids are at the butt end of this vitriol of rolling up everyone’s problems and bugbears and pinning it all unfairly as ‘their fault’ through all this paper-writing just because of the kpi explain why we are over budget (and we won’t probe that explanation as long as we want to believe it) culture

to combine this with encouraging no investigation and whilst I can understand not wanting to go too hung ho with kids at leads an open and watchful eye on ‘maybe there is something’ and then even at the other end of things what seems insufficient cause of death stuff and systems given this culture seems a real issue. Shouldn’t there be something specific there specifically for these cases just by virtue of having been given that label at any point in life? Ie all MUs get a full post-mortem with the main aim of seeing if there was something (whether missed or a new disease etc). To check certain conditions aren’t commonly being found as missed in these ?

In fact shouldn’t one of the primary specialisms involved in MUS be that post-mortem side, including scientists for the more biochem stuff too? Oh and there should be a specialism to do with medical records, so that any later diagnoses are being added to the MUS register to see what either develops later (Mus being early warning) or just plain missed because of this idea/ideology/process? And ALL involved in that MUS diagnosis and specialism have to get informed each time it turns out they get /had something else . Particularly the legal side of things given how closely linked this is to false Fii accusations? They deserve to know common missed diagnoses if we have a justice system in this country at all surely?

So many might have other things and there might be so much to be learned from different stages and approach to this it’s so sad to think even at that point no one is checking in a way that puts aside the blame but could stop future issues or inform misinterpretations etc