Why So Many Doctors Doubt Patients With Long Covid | Psychology Today

Why So Many Doctors Doubt Patients With Long Covid

(Author is a psychiatrist with LC)

Key Points

• People with Long COVID experience stigma and dismissal from healthcare providers.
• Medical education potentiates stigma and mistreatment of individuals whose illness is not easily objectively identified.
• Trying to treat Long COVID with psychotherapy alone is like trying to meditate away diabetes without insulin.

 

(I may be misunderstanding something due to cognitive dysfunction?)

I found this article fairly infuriating because the author still apparently believes that somatic symptom disorder and conversion disorder are valid illness categories rather than pseudoscientific nonsense.

The issue he's raising is that his colleagues are too quick to shove a patient, particularly one with LC, into the SSD box.

Apparently having LC yourself isn't enough to make you realise that Emperor Freud is wearing no clothes.

 

His viewpoint is a product of his training - he is now much more informed than many in his profession by personal and more recent professional experience but Not Fully There Yet™. I found his previous letter in The Lancet pretty reasonable though.

While it is pay-walled, the author has a screenshot of the whole article pinned on Twitter, so I think it's OK to reproduce in part here (my emphasis).

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Many people encountered previous providers who were unable to offer hope or who offered only false hope. They were told to wait it out, or were told that objectively nothing is wrong, after a few quick screening tests. Clearly, their functioning is radically disrupted; how can nothing be wrong? Some are referred with a suggestion that their symptoms are caused or worsened by psychology. They might have experienced palpitations that come with anxiety or fatigue that comes with depression, and can clearly describe that this is different. Yet skepticism abounds, and in a world in which evidence-based medicine is the gold standard, those with a disease that has yet to establish an evidence base are lost. Some are able to find a provider who will listen to them and express a willingness to restore quality to their life. Many cannot, and are tired of waiting.

At best, comorbid psychiatric symptoms might trigger a referral for psychological support; at worst, individuals with no psychiatric symptoms are told only a psychiatrist can help.

Then, they meet with me. While I can offer support or psychiatric treatment, I cannot offer much more. Who treats the crushing post-exertional symptoms, immune dysregulation, or vasculopathy? It sometimes feels as though I am trying to treat depression in a person whose oncologist can provide zero prognostic data and zero treatments.

My medical training taught me to recognise disease through illness scripts. It did not teach me how to treat those in whom the illness scripts are currently being written. Had I not been a patient with long COVID myself in 2020, who knows how long it would have taken me to learn the value of combining flexibility and creativity with empathy and curiosity.

Despite my own challenge of holding on to hope at times, I know there are researchers who are uncovering pathophysiology and investigating treatments. I know that one day this will lead to improved quality of life for my patients.

Until then, many will continue to suffer. Some told me they were hesitant to come to psychiatric treatment for fear their non-psychiatric symptoms will no longer be taken seriously. Indeed, this fear of dismissal is based on prior experiences they have had with other providers who have been quick to shoo them off, mistaking their anxiety and urgency for recovery as causative rather than a correlation, and tightly wrapping it up in a psychogenic bow. It is deeply unfortunate that these experiences undoubtedly prevent many from receiving the care they may need. When we get caught up in academic debates on Cartesian dualism and somatic symptoms, we run the risk of allowing our patients to get caught in the crossfire.

Our best way of treating patients starts with aligning with them. We must be sure not to assume that we know; humility and self-skepticism go a long way. For now, all we may have is hope, but "where there is hope, there is life".

 

Thanks for posting this @SNT Gatchaman. It's a very good letter.

 

Skillfully written but very detached and retains the potential for deep disingenuity.

It is about empathising with patients to gain their trust but not necessarily believing them. The author accepts medical knowledge is incomplete but still adheres to the hocus pocus of the unconscious and somatisation which imho, from an empirical neurological perspective, is shamanic gobbeldy gook.

In the nervous system, where a decision inhibits an impulse it does not build up a back pressure and ramify like pressurised pipework or some abstract demonic entity with a life of its own, it terminates. The Central Pattern Generators involved may still generate impulses and decisions may be reevaluated but there is no basis for assuming somatisation will result. The human brain evolved as a decision making organ, it stands to reason it wont make itself dysfunctional by doing what it evolved to do in the way it evolved to do it unless there is something physically wrong with the biology of the nervous system. Somatisation is based on an incorrect model invented by a tobacco marketer reinforced by generations of placebo effect outcomes.

This writing reminds me of Garner before he went LP balmy and completely discredited himself with everybody... not to mention Lewis Carroll’s Walrus.

There is a lot at stake for the "professionals" involved and those who rely on them, like the insurance companies.

They want to maintain a facade of unimpeachability. The likelihood is that if the revelations of personal experience from one of their own prove at all significant to the wider world in a way which undermines the gobbeldy gook of somatisation and the cheap insurance settlements it permits, moves will be made to draw them back into the fold, or ruin them.

 

"Yochai Re’em, M.D., is a psychiatrist and psychotherapist in New York City, and a Clinical Assistant Professor of Psychiatry at Weill Cornell Medicine. He completed his psychiatry training at NewYork-Presbyterian Hospital/Weill Cornell Medicine and earned his medical degree at NYU. Re’em has a special interest in Long Covid; he has treated individuals with Long Covid-associated psychiatric and psychological challenges, he has written on the topic in STAT News, the Wall Street Journal, and Lancet Psychiatry, and he has contributed to research efforts with the Patient-Led Research Collaborative. He maintains a private practice in New York where he treats individuals with a spectrum of psychiatric and psychological concerns."

My bold - looks like 'psychotherapist' is doing a lot of the heavy lifting in his LC writing.