Psychology Today; Psychiatry’s Mismatch with Primary Care, 2021

M

Milo

Senior Member (Voting Rights)
Taking another swing at medically unexplained symptoms…

Exerpt:
Many primary care patients with a mental illness do not offer psychological symptoms; instead, they present long-term physical symptoms. Trained in diagnosing chronic diseases, the clinician pursues these clues in the hopes of making a diagnosis. Sometimes they find a disease, but just as often they do not, the latter patients designated as having medically unexplained symptoms with such diagnoses as chronic pain, irritable bowel syndrome, chronic fatigue syndrome, or fibromyalgia
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Link to the Psychology Today article here
 
How pedestrian of the author, who should, by the way, retire completely and not write articles because he seems confused. Which came first, the physical disease or the mental illness. Not everyone is depressed by their limitations, by the way. Frustrated at times, but one adapts, no?
 
What a simplistic pile of nonsense. He seems to be saying all of us here who have ME/CFS must, by definition, have a mental illness. And further that our mental illness both causes, and is caused by, having disabling physical symptoms.

So my having physical symptoms makes me feel depressed and anxious, according to him, and further, is easily treatable. But according to his logic, if I still have my physical symptoms after he has successfully treated my 100% probability mental illness, then the remaining physical symptoms he hasn't treated will still have 100% chance of making me mentally ill.

Either he or I or probably both seem to have lost the plot. I give up.
 
https://www.psychologytoday.com/us/blog/patient-zero/201812/the-diagnosis-and-treatment-chronic-pain
Robert C. Smith is banging the same drum as he writes why people with chronic pain should not get opioids. Apparently the following treatment solves all: (it involves a lot of patronising and having patients set goals to, among other things, play golf).

EDUCATION. We do not tell the patient what the problem is or what needs to be done without first determining their understanding (“What’s your understanding of what’s going on, what treatment do you think should be given?”). We next clarify any misunderstanding (“…No, the OxyCodone will not get rid of the pain with an increased dose.”). We then describe the treatment we believe is needed (“…We’ll want to start an antidepressant, which is a much better pain medication, and slowly reduce your OxyCodone over the next several months.”). To be certain we have not confused the patient, we often ask them to repeat their new understanding.

COMMITMENT. The next step is to get the patient’s verbal agreement to participate in the treatment program. It is essential they know and articulate that they will need to comply with the treatment plan, so that they become an active partner with the clinician in getting better.

GOALS. Patients often are so disabled, depressed, and discouraged that they have forgotten the potentially good things in their lives they’ve had to give up. Establishing goals (for example, see kids graduate; play with grandchildren; rejoin bridge group; play golf; go to church) helps to set a positive tone and facilitates involvement in the program by reminding them of what’s worth living for in a more healthy future.
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Patients often are so disabled, depressed, and discouraged that they have forgotten the potentially good things in their lives they’ve had to give up. Establishing goals (for example, see kids graduate; play with grandchildren; rejoin bridge group; play golf; go to church) helps to set a positive tone and facilitates involvement in the program by reminding them of what’s worth living for in a more healthy future.
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I find I often forget I want to go to relatives’ weddings, godchildren’s graduations, family funerals and so on (sarcasm alert); does this person even read what he has written. He is setting people up for failure, for anxiety and depression. Let’s undo the decades of coming to terms with a long term disability by regularly rehearsing what you have lost.

I did actually get to Church four days ago for the first time in some seven years and consequently have so far have had four days in bed. It was the funeral of the husband of someone who had worked for me for over twenty five years, and was only a possibility because it was in my home village and I had someone to drive me the 500 yards to and from the Church. Ignoring the fact that I was not expecting more than half the congregation to be mask free and hymns to be sung, advanced warning of which probably would have led to a different decision, this was the result of a week’s planning and calculated balance of risks, and significant subsequent cost.
 
chrisb said:
In fairness to the guy these ideas were probably cutting edge, state of the art, when his career was at its height. When would that have been? 1980's? those he cites- Kroenke and Katon, were going strong.
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And he's not taken on any new ideas or thoughts in 40 years? Perhaps he's spent too much of his time patronising other people and lost sight that there's a whole big wide world out there and our understanding of it shifts all the time.

Maybe someone should remind him to stop spouting tired old ideas and start observing and thinking for himself?
 
Hutan said:
https://www.psychologytoday.com/us/blog/patient-zero/201812/the-diagnosis-and-treatment-chronic-pain
Robert C. Smith is banging the same drum as he writes why people with chronic pain should not get opioids. Apparently the following treatment solves all: (it involves a lot of patronising and having patients set goals to, among other things, play golf).
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The most insulting thing about the whole Opoids crackdown is that prescription rates have declined, yet there is no effect on opioid related deaths in the USA.

upload_2021-7-26_22-53-14.png
upload_2021-7-26_22-53-35.png

(prescription rates are /10000)

I don't see a cause and effect relationship there.

data from:
https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
 
Snow Leopard said:
The most insulting thing about the whole Opoids crackdown is that prescription rates have declined, yet there is no effect on opioid related deaths in the USA.

I don't see a cause and effect relationship there.

data from:
https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
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This is pure speculation based on just eyeballing the graphs, but …

It is possible that reduced prescription of opiates, results in fewer deaths associated with prescribed opiates on the basis of these graphs, though I have no idea if the apparent relationship is statistically reliable. However given the ongoing increase in opiate deaths overall it could also be that the reduction in prescriptions results in increased deaths overall because of people shifting to unregulated sources and suppliers, with no medical supervision of their ongoing use.
 
Hutan said:
https://www.psychologytoday.com/us/blog/patient-zero/201812/the-diagnosis-and-treatment-chronic-pain
Robert C. Smith is banging the same drum as he writes why people with chronic pain should not get opioids. Apparently the following treatment solves all: (it involves a lot of patronising and having patients set goals to, among other things, play golf).
Click to expand...
This is obviously a complete perversion of informed consent and anyone who finds nothing objectionable to this should not work in health care. There has to be a mandate for medical professionals to tell the truth and nothing but the truth, the privilege to lie has been abused to an absurd degree and clearly no one can be trusted with that if even in those circumstances it is abused so excessively and systematically.
 
Peter Trewhitt said:
This is pure speculation based on just eyeballing the graphs, but …

It is possible that reduced prescription of opiates, results in fewer deaths associated with prescribed opiates on the basis of these graphs, though I have no idea if the apparent relationship is statistically reliable. However given the ongoing increase in opiate deaths overall it could also be that the reduction in prescriptions results in increased deaths overall because of people shifting to unregulated sources and suppliers, with no medical supervision of their ongoing use.
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The US (and the UK more and more) fudge the numbers by including all abused drugs together including heroin and then using that to justify not treating pain.

People who buy heroin, fentanyl, pregabalin and so on from a dealer are counted alongside people who become addicted from being prescribed a drug yet the number who become addicted when taking the medication as prescribed is low.
 
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