Patients With Somatoform Disorders Are Prone to Expensive and Potentially Harmful Medical Procedures..., 2021, Schneider et al

Andy

Andy

Retired committee member
Full title: Patients With Somatoform Disorders Are Prone to Expensive and Potentially Harmful Medical Procedures – Results of a Retrospective Cohort Study Over 15 Years

Abstract

Background: Patients with functional somatic syndromes (FSS) might be prone to potentially harmful medical investigations in ambulatory care. The primary aim of this study was to investigate which diagnostic tests such as X-ray, CT scans, MRT, and surgical procedures FSS patients receive in an outpatient setting. Its secondary aim was to evaluate the extent to which coordination of care by family physicians reduces health care utilization.

Methods: Retrospective cohort study using longitudinal regression analysis of routinely collected claims data. FSS-patients were weighted in the regression model to allow a representative comparison with the Bavarian population. The observation period was from five years before until ten years after first FSS diagnosis.

Results: The cohort comprised 43,676 patients with a first FSS diagnosis and a control group of 50,003 patients. FSS patients exhibited continuously increased health care utilization over the 15 years period. The relative risk (RR) for FSS patients to undergo X-ray reached 1.48 (95% confidence interval 1.46- 1.50), for CT scans it was 2.01 (1.94-2.08), MRI 1.91 (1.87-1.96), and outpatient surgery 1.30 (1.27- 1.34). Compared with patients under family physician centred care, patients with no such coordination showed higher service utilization, with ambulatory care costs up to 1.37 (1.36-1.38) times higher.

Conclusions: Patients with FSS more frequently undergo potentially harmful and costly diagnostic testing and outpatient surgery. Coordination of care is associated with lower health care utilization.

At time of posting, only abstract on Pubmed is available, https://pubmed.ncbi.nlm.nih.gov/33814040/
Should be published eventually in the journal at https://doi.org/10.3238/arztebl.m2021.0135
 
Sick people seek medical care. Doctors confused about why, certain that their beliefs about those patients not being sick must mean reality is wrong. Part 30,473.

Although it does not take a genius to understand that leaving sick people without health care is more expensive overall, this study has little to do with "somatoform" something or another, but rather over the gaps in medical knowledge and how medicine deals poorly with its own failings.
 
Actually it could just as easily read "Patients with cancer are prone to expensive and potentially harmful procedures."

All patients start with an unexplained illness, what we need to know is how many get diagnosed as a result of each procedure. Without testing how is it possible to know if someone has a somatoform disorder (a more scientific sounding label than medically explained but with the same meaning).

They are really looking at how soon we give up testing patients when we have no answers so knowing what proportion are finally diagnosed after these expensive tests is the important thing.

It is all set up to leave the impression that these disorders are an expense wasted on patients who are trivially ill. It should be an incentive to find the true cause so the right test exists but instead the blame is put on patients being self indulgent.
 
Now published open access here, https://www.aerzteblatt.de/int/archive/article/219799

My bolding.
"Cohort

The cohort consisted of patients aged between 18 and 50 years with a first diagnosis of one of the following functional somatic syndromes in the year 2010: chronic fatigue syndrome (CFS: ICD-10-GM codes F48.0 and G93.3), irritable bowel syndrome (IBS: F45.32 and K58), other functional intestinal disorders (FID: K59), fibromyalgia (FM: M79.7), tension headache (TH: G44.2), and somatoform disorder (SD: F45.0). Children, adolescents, and patients older than 50 years were excluded to avoid misclassification of symptoms or confusion of functional physical complaints with somatic diseases. Patients were excluded if observed for less than 2 years before or after first diagnosis, thus ensuring an adequate period of observation.

A control group was drawn from the pool of patients with no recorded FSS diagnosis who met the same inclusion criteria. The sample was stratified by age, gender, and place of residence, with the number of participants in each group chosen to be representative of the Bavarian population."
 
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