Who benefits from multidisciplinary care in functional somatic disorders? Identifying cost-effective patient selection... 2026 Hammerman et al

[Andy]

Full title: Who benefits from multidisciplinary care in functional somatic disorders? Identifying cost-effective patient selection through diagnostic classification groups

Abstract

Background

Functional Somatic Disorders (FSD) significantly impact patients’ quality of life while placing a substantial economic burden on healthcare systems. Identifying which patients achieve reductions in healthcare costs through multidisciplinary care remains crucial for optimizing resource allocation.

Methods

A retrospective analysis examined healthcare utilization and costs during the year preceding and the year following patients’ initiation of treatment at a specialized, multidisciplinary clinic in Israel. The clinic combined medical care with mind-body therapies - including cognitive behavioral therapy, hypnotherapy, and physiotherapy. Using baseline characteristics, patients were divided into Diagnostic Classification Groups (DCG). A multivariable analysis was performed to ascertain the impact of DCG on annual, average changes in healthcare utilization and costs after treatment.

Results

Data from N = 685 patients were analyzed. Reduced healthcare utilization and costs were observed among approximately 56% of the population receiving multidisciplinary care. Mean annual cost reductions were 1,367 ILS per patient. Specifically, significant reductions were observed in hospitalizations (-1,723 ILS) and diagnostic procedures (-495 ILS). Patients with simple FSD and stress-exacerbated diseases showed significant cost reductions (P < 0.05), while those with organic disease or difficult FSD did not demonstrate significant changes. Analysis by DCG revealed that baseline diagnostic classification significantly predicted cost reduction.

Conclusion

Healthcare utilization and costs were reduced among FSD patients receiving multidisciplinary treatment, with outcomes varying by diagnostic classification. Baseline diagnostic classification reliably predicted treatment cost-effectiveness, underlining the economic value of collaborative care for patients with simple functional disorders and stress-exacerbated diseases. These diagnostic patterns provide healthcare policymakers with selection criteria for multidisciplinary programs and inform the development of tailored interventions.

Open access

 

[V.R.T.]

multidisciplinary care

This is why we need advocates to stop using this phrase.

 

[bobbler]

Bit of an ironically worded question (given I know they intend something different to what I read which is akin to ‘follow the money’) that should probably be being asked instead of this gravy train clone

 

[V.R.T.]

But if an ironically worded question (given I know they intend something different to what I read which is akin to ‘follow the money’) that should probably be being asked instead of this gravy train clone

Yes who benefits? Governments and service providers and healthcare administrators and insurance companies.

Not the bloody patients, thats for sure.

 

[Lou B Lou]

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

 

[bobbler]

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

Indeed I’m pretty sure that no one was healed by any of it

Maybe some were gaslit enough to no longer be sure they werent just going mad and imagining things for years and to think saying they aren’t better is just admitting they aren’t trying hard enough yet but one day…

But most .. I think we need to start using the term harm

None of this is nice to be on the receiving end of in reality even if those doing whatever think it’d be ‘a nice thing’ based on not having proper empathy that these aren’t their mate looking for a treat (and they’d want to be sure they like it) getting a posh spa day but very ill people who didn’t deserve to have their time wasted

And the pressure for all those attending to comply and perform is unkind, cruel and harmful in this context not ‘nice to be nice’. Giving a kid a lollipop to shut up and sit over there and ‘put a smile on your face’ after they’ve actually just been bullied or really hurt themselves without acknowledging the bullying or injury is the context not the disingenuous ‘but a lollipop is nice’ .

But it’s worse because to say it out loud most healthy people don’t even like doing that sh** . They only don’t say it so much because they know someone who sells it as their money maker and one or two might really like it when they choose it out of hundreds you know, but there’s always that sense of not being sure they really do. And they can choose not to do it.

It’s like enforced fun at a staff xmas party where diverse ages are forced to all enjoy some game. But worse.

And the real harm comes from having people who are into delivering these types of things (and kidding themselves EVERYONE attending loves it when at might one or two might like it… or just be people pleasers /desperate for something else it gives them) are then given powers over individuals who have genuine other needs and can’t walk away. For such teams to then let that type guess at and make up ‘problems’ to write on notes causing havoc and reducing their access to future care and services way beyond just medical is a scandal

Would one of these writers want to go to a GP or hospital for a terrible illness or a ripped muscle and find themselves patronised and shoved off under the powers of someone like-minded with the local who runs Pilates classes and relaxation and then find out they get to go to meetings suggesting the disease you have isn’t that big maybe you just have family problems and don’t think right , particularly if you don’t act healed and attend their 10 sessions on grinding annoying things that you aren’t into and don’t heal anyone during you lunch hour + extra work time your boss is annoyed at you for having to take and must make up.

All because some doctor didn’t like your face or was forced to consign you to that pile by this manifesto so your not ever being gotten to the bottom of and treated is covered up because you got sent to ‘the special dept’ ?

So it’s not just harm but hurtful to do to someone and devious too using coercion on other parts of life (work) already compromised by their illness not being treated to prevent access and then claim it’s cos they wouldn’t complete the farce ‘high bar’ that took the Mickey out of them and their time and situation.

And most ill people they are dealing with have far more devastating illnesses than that and they are contributing to their life being trashed rather than their illness addressed and life as it was adapted as best it could in time whilst it could still be rectified and they still had their job friends etc. They know this, everyone does that there is a window which this nonsense, if it didn’t consign them to a label they’ll never escape anyway, is wasting and letting slip away vs just someone being pragmatic could help with.

It seems very devious when I think about it and how those pathing it out must know this

 

[NelliePledge]

Yes who benefits? Governments and service providers and healthcare administrators and insurance companies.

Not the bloody patients, thats for sure.

Beat me to it, mainly the “therapists” from being employed as emperors with no clothes- jobs set up so it’s always the patients fault if they dare to point out the so called treatment doesn’t actually work.

Job creation scheme

 

[Turtle]

Cost reduction is more important to write about than whether it works or not.
Not coming back for seconds does not mean the patient is OK now.
@bobbler A few years back I ripped a muscle in my upperarm, medics don't do anything about that either.

All the angry reactions here on these kinds of "care" should be enough not to spend any more money on researching it.
Wouldn't we all run towards multidisciplinary care if it really worked?

 

[Utsikt]

Patients with simple FSD and stress-exacerbated diseases showed significant cost reductions (P < 0.05), while those with organic disease or difficult FSD did not demonstrate significant changes. Analysis by DCG revealed that baseline diagnostic classification significantly predicted cost reduction.

So the people that would probably be expected to improve naturally did improve naturally, and the people that had more severe illnesses didn’t improve.

Meaning that the intervention is probably useless. Making it a net loss financially.

 

[rvallee]

Patients with simple FSD and stress-exacerbated diseases showed significant cost reductions (P < 0.05), while those with organic disease or difficult FSD did not demonstrate significant changes.

All you have to do to reduce costs is to only do the easy tasks, especially if all you do with the easy tasks is to block anything else from being done. Just like if you feed people less, you will save on food. If you feed them less than they need to survive, you will save even more on food. Why don't we try that everywhere? Let's have hospitals only focus on people with mild illnesses. Bam! Automatic cost reduction. Just don't count it whole, only focus on one pocket. This is exactly what the 'fatigue' clinics typically do, same with the LC clinics, they simply refuse all but the mildest patients.

There's this unmistakable pattern where BS studies try to 'predict' things, fail at it, but assert that it does anyway. But they never, truly never, actually wonder why they never actually achieve anything. And as is typical with 'holistic' medicine, it could not be any less holistic. They strictly look at direct health care expenses, without any consideration for how much it costs for someone to be disabled for the rest of their lives, especially considering how much government spending goes into turning them into healthy, productive adults.

Unless I missed it, they don't actually predict anything, and definitely don't identify anyone. Not anymore than you can predict which trees in a forest will grow taller by waiting until they all fall from age and look at which were the tallest at the point at which they were their tallest. It's really baffling to see smart people say such foolish things. This would be hilarious satire if it wasn't a human rights catastrophe.

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

Don't even need for the patients to avoid anything, they are filtered out. All it takes is not caring about patient outcomes, or ethics, or morality, or doing any self-reflection.

 

[Sean]

Medicine's version of cooking the books.

 

[dave30th]

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

That occurred to me.

 

[Sean]

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

That is exactly what happens.

Then clinicians pat themselves on the back for having 'successfully treated' the patient. By which they really mean they have successfully fobbed the patient off and don't have to worry about dealing with them and being confronted with the reality of having failed to help the patient, and worse.

Patients are not stupid. They eventually realise they are being gaslit and not being helped at all, and that the health system will not accept being told that fact, and can get very nasty indeed in its denial and dismissal.

 

[Arnie Pye]

Could be that the patients avoided healthcare facilities after the 'multidisciplinary clinic' experience, realizing that there was nothing else for them except more 'mind-body therapies'.

I remember a time (20+ or 30+ years ago or more) when, if I went to see my GP and he couldn't diagnose me, and my problem seemed serious enough, I would sometimes be sent to a specialist in my local hospital. And if that doctor couldn't diagnose me either, they would pass me on to someone else in the hospital. Eventually the "pass the buck" and "pass the parcel" would stop and I still might not be diagnosed. Although I am not suggesting that the medical profession should go back to that, nowadays almost every decision seems to be made by the GP, and frankly (in my opinion) many GPs don't know enough to do that.

Edit : When everything changed the routine became even more patient unfriendly, and the GP would send the patient to hospital, then the specialist would send them back to the GP, then (if the GP could be bothered) they would send the patient to another specialist, and that specialist passed the buck back to the GP, and theoretically I suppose the GP could send the patient to yet another specialist. But generally speaking the patient never gets sent anywhere by the GP because they are confident they can diagnose anything serious, so if they can't find anything wrong you get labelled an attention-seeking hypochondriac and find it difficult to get any treatment at all in future. (This seems to be what happened to me in my teens, and it has affected my medical care my entire life. I'm now in my 60s.)

 

[bobbler]

I remember a time (20+ or 30+ years ago or more) when, if I went to see my GP and he couldn't diagnose me, and my problem seemed serious enough, I would sometimes be sent to a specialist in my local hospital. And if that doctor couldn't diagnose me either, they would pass me on to someone else in the hospital. Eventually the "pass the buck" and "pass the parcel" would stop and I still might not be diagnosed. Although I am not suggesting that the medical profession should go back to that, nowadays almost every decision seems to be made by the GP, and frankly (in my opinion) many GPs don't know enough to do that.

Edit : When everything changed the routine became even more patient unfriendly, and the GP would send the patient to hospital, then the specialist would send them back to the GP, then (if the GP could be bothered) they would send the patient to another specialist, and that specialist passed the buck back to the GP, and theoretically I suppose the GP could send the patient to yet another specialist. But generally speaking the patient never gets sent anywhere by the GP because they are confident they can diagnose anything serious, so if they can't find anything wrong you get labelled an attention-seeking hypochondriac and find it difficult to get any treatment at all in future. (This seems to be what happened to me in my teens, and it has affected my medical care my entire life. I'm now in my 60s.)

I think we have to also note how inappropriate the governance is of a move towards more control to GPs given the uk set up means they are just businesses. So the idea of an nhs ‘for all’ was always bs for me due to the GP surgery I was under most of my life and their known money making focused attitude of the person in charge there. So imagine how it was for those picked out as face doesn’t fit write anything in the notes to wreck their voice and life people under that.

There is a major power issue and it’s never operated right and is vastly concerning.

The way GP practises work across the country means you can’t ensure anything consistency or rights wise. It’s an individuals and businesses making business decisions for themselves as much as a ‘service’ . And stuff like this is playing into increasing the grey area to give self talk about the morals and bridges cognitive dissonance between profit vs the individuals ruined choices (by pretending they aren’t ruined by you, it’s themselves for being in the way). Rhetoric they can use. And practises don’t have loads of GPS who all can be independent basing decisions on patient need when they are under not just their boss running the practise but the ICB and royal colleges inputting into them having to follow decision charts rather than look at what they think the patient has in many practises.

I don’t recognise what you talk of even from years ago (tho I know that’s what others said they got at the time because they never believed me) because I never once in decades got referred anywhere and even hospital notes weren’t accurately put in my records (played down to different milder versions of a condition or not added or given spin) which ruins even when I finally changed GP surgery. But it makes sense.

I find it bonkers now I see more have this in gps as over the decades this game playing has been enforced as the norm and lots of businesses have entered that everyone plays along pretending giving gps more power over a patient seeing someone who could say they were wrong or just being able to access the system so dystopian. Practises are entities that can make profit

And I certainly have due to how the one I was stuck under always operated not even needed to read between the lines in the bps stuff inc the 2007 cfs guideline and the mus bs about the messaging via eg rcgp on selling certain things to practises (to impose top-down on all gps in them - the head would check all prescriptions and remove things as well as referrals) as ‘saves you money on obligations’ get out of jail feee card if you can take someone needing investigations and label them with hypochondria/mind makes them ill first then somehow they’ve no responsibility to investigate anything and bigotry causing ‘missed’ diagnosis for decades is legally just what , a pretend mistake (a consultant for something that I’d had to go private for and turned into an nhs emergency from there despite what I assume had been a rude referral letter from them looking to undermine even a private appointment, told me what I had had been caused by ‘something else the GP should investigate’ and following an initial GP appt looking into it a partner then took over and told me my only option was cfs - and I knew at that point they were just using that 2007 criteria explicitly as a way to not investigate, they then said we only refer for diagnosis not treatment and gave me bad advice themselves, and didn’t even treat or acknowledge the extra biomedical things found at that appt).

I think everyone having to pretend these are beliefs is facade enough not bigotry that needs to be drilled out and sacked out of a service claiming it’s for all when it’s not for those wrecked by that - and they know what they are doing then get to pretend over decades with each stroke they use that again and again to turn up the ratchet in destroying you that somehow that destruction of you, your opportunities and your health ‘wasn’t them’ - and that gets my goat even more that they then get to look at the person pressing their foot on their neck further and fake innocent face say ‘no I don’t see why working and having a family would be hard - you must just be a useless person’ and uses that to add another label to you unless you hide the injury to your life they caused.

But it’s incentivized not even to save money to taxpayers just at a micro level

So we’ve goodness knows how many people in this country he bps infiltration stuff has been used to justify excluding from not just access to any health service but for access to human rights and all other services gerrymandered and their reputation rewritten just by the few individuals running that practice and that saving only really going to a few people . But the money-making of building kingdoms in its name going to many others.

Whilst they take people with talent and things that at that age could lead to a manageable life , with things, and futures and events and took that all . After decades of no birthdays and compromised other peoples birthdays and weddings you realise they never intended it to end. And there never will be a ‘one day’ . And that slow destruction despite you hurting yourself staying stoical clinging on for the ‘one day’ will just be turned up a notch each time then blamed not on those who did it but those who survived it for so long day by day as if they are the losers - that’s what the mind bs is. It’s just slander and a roundabout way of muttering to other entitleds who had it easy some phrase inferring that person wasn’t worth listening to or bothering about as if they wouldn’t have prospered if they’d had a normal chance , nevermind what they had. Because sure as heck the other way around I’d wager they wouldn’t have done as well in our shoes as most of us manage. And yet they then hold that tenacity against us as if it means our disability doesn’t exist - bigotry again.