The FHJ debate: The NHS is failing to provide services for patients with symptom-based disorders, 2025, Burton et al

Utsikt

Utsikt

Senior Member (Voting Rights)
The FHJ debate: The NHS is failing to provide services for patients with symptom-based disorders

Burton, Chris; Ellis, Benjamin

Burton says the NHS is failing.

Ellis says it’s a false premisse.

Abstract

Web | DOI | Future Healthcare Journal
 
Burton:
Current conceptualisations of symptom-based disorders are genuinely biopsychosocial (with all three components being important, rather than just using the term as a euphemism for ‘not really medical’).9 The NHS has a range of coaching and therapeutic services that can be useful for many patients with symptom-based disorders, but we need to get better at actively referring people in a positive way: guiding people towards other services, rather than signposting away from mine.
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Finally, we don’t do enough to promote therapeutic optimism. Many people with symptom-based disorders are stuck, without an authoritative diagnosis or formulation, stigmatised and bounced between services. However improvement, and sometimes recovery, are possible. This can be difficult for patients to hear in the current climate of illness identity politics and social media bubbles, but it is important. Hope – the possibility that things can be different – is important.
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Ellis:
The evidence is clear. People with symptom-based disorders don’t benefit from being ‘sliced and diced’ by traditional medical models focused on identifying and treating specific pathological processes. What people need – what the NHS is well placed to deliver and increasingly provides – are services emphasising long-term, trusting relationships with healthcare teams, clear explanations of these confusing, distressing and disabling symptoms, and support to achieve personal goals and priorities, in line with people’s values and beliefs.
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The reality is that the NHS, through its evolved primary care model and innovative services, provides exactly the kind of integrated, person-centred care that robust evidence shows people need. The NHS is pioneering new approaches, implementing evidence-based interventions, and transforming care delivery. Rather than declaring failure, we need to celebrate, support and expand what’s already working. The solution is to build on foundations that, despite challenges, remain fundamentally sound.
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Illnesses have symptoms. If they didn't the patient would never know they were ill. So all illnesses eventually have symptoms and are symptom-based, in my opinion. It therefore suggests to me that the authors are just trying to reduce the number of people who get proper investigation, which is what BPS has been trying to do for decades.

I'm not aware that BPS theories have improved the health of any nation. Instead, people are starting to die younger than they used to.
 
Oh goody, I can't wait for my local Goop-clone NHS provider to offer me some wellness coaching and a bit of social prescribing. I'm sure some positive thinking and joining the local papier mache group will do wonders for my OI and pain. Or perhaps I could learn to belly dance and join a witches coven.
 
Current conceptualisations of symptom-based disorders are genuinely biopsychosocial (with all three components being important, rather than just using the term as a euphemism for ‘not really medical’).9 The NHS has a range of coaching and therapeutic services that can be useful for many patients with symptom-based disorders, but we need to get better at actively referring people in a positive way: guiding people towards other services, rather than signposting away from mine.
Click to expand...
Finally, we don’t do enough to promote therapeutic optimism. Many people with symptom-based disorders are stuck, without an authoritative diagnosis or formulation, stigmatised and bounced between services. However improvement, and sometimes recovery, are possible. This can be difficult for patients to hear in the current climate of illness identity politics and social media bubbles, but it is important. Hope – the possibility that things can be different – is important.
Click to expand...
The hell are these people talking about? Their bullshit ideology is responsible for this, and they have always presented themselves as the solution, so this is nothing new but it still looks appalling. Arsonists who work for the fire department wondering what's up with all those fires they keep starting. Really? With their solutions being "more fires, people love those, it keeps them warm"?

This junk he says in the second quote is just begging for more bias, because the maximum bias they have been allowed to get away with is not enough to do anything more than keep the pretense that anything they are doing is worth doing. It's stagnation by design, all of which causes nothing but permanent damage in that years of life lost to illness are permanent, no one ever gets them back.

These people have zero clue what they are doing or even talking about. They are also in complete control of the situation and are responsible for this failure. And they keep pretending like they mean well and it's all good anyway because all it needs is some more optimism and coaching.

We are trapped in a nightmare by fanatics while the rest of the profession just looks away, content that they don't have to deal with us. Which they still have to anyway. Millions of lives traded at enormous costs, and they want more. This is insanity, absolutely delusional failure and dereliction of duty at all the levels of health care with even minimal responsibility.
The evidence is clear. People with symptom-based disorders don’t benefit from being ‘sliced and diced’ by traditional medical models focused on identifying and treating specific pathological processes. What people need – what the NHS is well placed to deliver and increasingly provides – are services emphasising long-term, trusting relationships with healthcare teams, clear explanations of these confusing, distressing and disabling symptoms, and support to achieve personal goals and priorities, in line with people’s values and beliefs.
Click to expand...
Well that's because until you figure out the pathological processes nothing works. Especially this psychosomatic junk. Good grief a child easily understands this. They keep telling us what we need, which ignores both what we actually need and what we tell us we need, and it's all based on the idea that they can both gaslight our reality and provide solutions based on trust and relationships, all of which is completely impossible because nothing they do has any bearing on reality.

Insane. Just total, pure insanity. Throwing virgins into volcanoes to appease gods isn't any more insane than this, it's on the same level.
 
Jonathan Edwards said:
Interesting to see someone even more wrong than Burton.
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I haven't read them but it sounds like they both accept the biopsychosocial framing and the need for these services, and essentially are just arguing about whether the NHS is implementing this approach effectively or not.

And yes, I'd heard you were being interviewed for Adam. How'd it go??? :)
 
In his comment, Chris Burton references his own trial of persistent physical symptoms, published in The Lancet, to indicate that "we can make a difference." But that trial had primary outcome results that were below the minimal clinically important threshold for the metric, as Joan Crawford and I wrote in a letter published by the journal. In their response to us, they completely avoided the central point--that the findings for the primary outcome were clinically insignificant.
 
dave30th said:
How'd it go???
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I got sidetracked chatting to this American guy about Trump's swollen legs. But I think we covered the ground.

This Burton/Ellis piece is the same old BPS garbage and maybe unusual in that they are having fun arguing which is the best way to deny people services.

But it strikes me that there is something seriously sinister about how this sort of debate can be paraded in a scientific journal. The motivation here is self-congratulation and major salary increases from toeing the medico-political line through merit awards and so on. And it is all done with such virtue signalling and woke correctness that it is likely to become (or remain) the norm in a way that the efforts of certain more abrasive political figures may not achieve.

There is an overt inhumanity here that makes Robert Burns seem wistful.
Man's inhumanity to man...

Things are going to change, but not through rational engagement with these people.
 
When they keep changing the name every 2-3 years they are completely stuffed. Medically unexplained symptoms, symptom based disorders, central sensitisation syndrome, FND ( I get some FND is real). Including IBS, POTS and migraine as the same disorder is silliness. A notorious physician started doing this in my part of the world and his career was finished in 3 years because their patients could see through it.
 
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