Blog: The Science Bit by Brian Hughes

Another great article, Turning the Nostalgia Up to Eleven:

https://thesciencebit.net/2021/11/24/psychogenic-me-cfs-turning-the-nostalgia-up-to-eleven/

 

https://www.s4me.info/threads/evide...sharpe-chalder-white.22905/page-8#post-394005

 

Medical haste, COVID-19, and the mythology of “Medically Unexplained Symptoms”

"Here is an extract from a lecture I gave last year for my colleagues at the Psychiatric Association of Turkey. It concerns the issue of so-called “Medically Unexplained Symptoms”:

I attempt to show how the primacy effect — a reliance on first impressions — serves to distort medical reasoning. For example, our first impressions of COVID-19 was of an illness characterised by high temperatures and lots of coughing (hence all those forehead thermometers and hand-washing). These impressions have remained influential, even though we now know that the fever/coughing stereotype is largely misleading: fatigue and headache are by far the most common symptoms of the illness, and most people who get Covid do not develop any fever or persistent cough at all. Something similar could be said about Long Covid too. The power of our collective first impressions — that people recover from Covid after a few weeks — is probably why governments around the world have been slow to acknowledge the scale of the Long Covid crisis.

The primacy effect hampers doctors as well as governments. As part of my lecture, I discussed this recent study of General Practitioners and the speed with which they form diagnoses. The study found that GPs tend to draw their conclusions rather quickly, especially when they believe a patient is not really physically ill but has illusory, psychosomatic, or hysterical symptoms.

Shockingly, the study found the following:

• It took GPs a median of just 12 seconds to decide that a patient’s symptoms were psychosomatic.
• In 50% of consultations, GPs had decided that symptoms were psychosomatic before the patients had even started talking.
• For those GPs who allowed patients to speak before attempting to diagnose them, the median time taken to declare their symptoms illusory was still just 132 seconds. In other words, they gave patients the physical “all-clear” in under three minutes."

https://thesciencebit.net/2022/06/1...-mythology-of-medically-unexplained-symptoms/

 

from the study Brian is referring to...

One imagines these are 'positivively associated' with Medically Explained symptoms too. If you are ill you stop being able to participate, & thus become more isolated. You also, well if you are rational & not a masochist, keep seeking healthcare (insert cynical laugh) thinking someone will care, pay attention and help you

Its crazy making the way they twist cause & effect.

 

One thing this tells us, arriving at it this quickly is not a coincidence, is that this is the product of training. Physicians are trained to do this. So it's pretty easy to see where it needs to be fixed: training people wrong is wrong in itself.

But actually it shows intellectual bankruptcy, more than anything. In any profession, it's expected that there are things you won't understand, many on a daily basis. Outside of an entry-level job anyway. Finding otherwise should be treated as massively suspicious. Uncertainty is a part of normal everyday life, even more so in an expert profession.

The entire profession can't deal with those, of course individual physicians will see things they can't explain in 12 seconds, even in hours or days. It's like mechanics or engineers and machines they can't repair. There will be many they can't repair, it's just how it is, it doesn't imply the existence of machines that are metaphysical, or whatever.

No one else creates an explanation for their ignorance. They're just the normal expectation in any human affairs, there are many things we don't understand, mostly because of time and technological & resources limitations. Absurd to think that this is still basically the exact same mistake going back over a century, unchanged. With the same horrible consequences, documented. And the only thing that can be expected to change, is that things get worse. This industry is going to have to go through massive reforms before it can shed its mythological baggage.

 

I had blood tests done by the NHS at the end of last year. They were the first ones I'd had instigated by my GP surgery in 8 years.

 

I think one of the unwritten things here if the UK NHS GP system is pathways, data and financial nudges etc + big workloads. Hence the 'gatekeeper' analogy. It is a machine in a way. Many real illnesses seem to have pathways that actively tell the GP to send the patient away with whatever (stress, probably short-lived bla bla) and come back in 2 weeks.

Unless certain magic words come up (which these days might well be on the 'whats the reason for your appt at time of booking) they are nudged to quick triage. Big concern/focus would be red flags within this.

And there have been drives (general or for specific GPs singled out) to reduce prescriptions, increase sending people off to certain places or put them on certain meds (eg statins) and the '11 illness KPIs' by which GPs annual payments are part-based (e.g. they 'meet target' if x% of those designated with asthma have an asthma check, x% of those with depression are given a card for IAPTS, % blood pressure have that checked or something - so they are often looking for one of these), referral lists for certain places are often closed (not just wait lists) so not an option and tests are often blocked even if GP refers for it by CCG.

With a complicated lots of symptoms issue not many GPs (certainly lower down the chain) will have choices that enable much else and to safely keep their job. There aren't even drop-down options for some things. Noting what 'costs the surgery money' (tests, referrals sometimes prescriptions), there's more process influencing diagnosis. These sorts of 'nudges' (enforced) create lessons that stick.

It mightn't start (or end) as thinking psychosomatic (they probably use a simialr phrase to time-waster, which starts as 'this will take time and they won't die tomorrow') - just all I'm allowed to offer you is x, the only box I can tick is y, and I have to get you out the door before you become a long appointment and I'm in a difficult position being asked for something I'm not allowed to offer. Noone ever returns to the GP who did this to them to say 'hey, turned out I had something really serious', so it is always correct.

 

ME, Long Covid, and the History of Medical Stigma (Podcast)

"I recently had the pleasure of talking with the folks at the Norwegian ME Association for their (excellently produced) podcast series.

Arising from my new book, we discussed the medical stigma in which an illness is falsely characterised as ‘psychological’ — post-viral conditions such as ME and Long Covid, for example, but also many others."

https://thesciencebit.net/2022/12/19/me-long-covid-and-the-history-of-medical-stigma-podcast/

 

Good God, it feels good to hear someone (and especially a psychology professor !) who truly understands, describes so well the reality that pwme(s) has been enduring for decades !! He clearly and simply outlines the reasons for the skepticism and stigmatization we experience from doctors and society at large. Brian Hughes is truly an excellent communicator. I'm not even " bilingual " and I understood him easily...

Among other things, he mentioned the following prejudice : Those among the groups in power in society see themselves as "normal" while they tend to see the others (for example minorities) as deviant, abnormal... And if I understood correctly, he also said that in the field of psychology, psy(s) begin to understand and change their point of view (ME is not a psychological disorder), and that it is rather the old psychologists who resist this change.

* added precision

 

ME, Long Covid, and the History of Medical Stigma (Transcript)

"Here is a transcript of my recent podcast with the Norwegian ME Association. In the interview, we discuss the medical stigma where post-viral illnesses, such as ME and Long COVID, are falsely characterised as ‘psychological’ due to poorly grounded stereotyping. The discussion touches on how medical opinion has become intertwined with wider political and economic concerns, and the implications of seeing people’s value solely in terms of their ability to be economically ‘productive’. Drawing on my latest book, I argue that history can be our guide in helping us to explain why Long Covid and ME are considered, by some, to be such challenging diagnoses.

The interviewer is Margrethe Gustavsen, Communications Officer of Norges ME Forening, the Norwegian ME Association. The transcript has been lightly edited for clarity and readability."

https://thesciencebit.net/2023/01/04/me-long-covid-and-the-history-of-medical-stigma-transcript/

 

Trial By Error: Psychologist Brian Hughes Discusses His New Book, “A Conceptual History of Psychology”

"My friend and colleague Brian Hughes, a professor of psychology at the University of Galway in Ireland, recently published his latest book—“A Conceptual History of Psychology: The Mind Through Time.” Rather than dating the field of psychology to the creation and growth of university departments of psychology in the late 19th and early 20th centuries, Professor Hughes traces its roots back to intellectual traditions dating back thousands of years."

https://virology.ws/2023/05/27/tria...-new-book-a-conceptual-history-of-psychology/

 

As always with David and Brian, a fascinating interview about this book on the Virology Blog.

 

Yeah it’s a textbook so it’s expensive! Bummer!

 

There's one extremely annoying thing about Brian's books and it's not even the $$$ though the price certainly doesn't help. But the most annoying thing is that they're not available as audio. Come on publisher, pull up your socks and make your textbooks accessible to many more people

 

Getting it Right: Addressing Myths about the 2021 NICE Guideline for ME/CFS

"Earlier this month, on World ME Awareness Day, I spoke at the Hope 4 ME & Fibro NI conference in Belfast. The event was hosted in the Stormont Parliament Buildings by Alliance Party MLA, Paula Bradshaw.

The title of my lecture was Getting it Right: Addressing Myths about the 2021 NICE Guideline for ME/CFS. I outlined eight pieces of misinformation regarding the new guideline (and about ME/CFS more generally) that are currently being pushed from certain quarters."

https://thesciencebit.net/2023/05/3...ths-about-the-2021-nice-guideline-for-me-cfs/

 

see also
https://www.s4me.info/threads/northern-ireland-news-from-hope-4-me-fibro.22133/#post-475095

 

Fantastic clear presentation @Brian Hughes thank you

 

https://twitter.com/user/status/1663934319138594817