Can internal medicine specialists diagnose functional somatic disorders (FSDs)? Training and comparison with FSD specialists 2024 Madsen, Fink et al

Andy

Andy

Retired committee member
Abstract

Background
Functional somatic disorders (FSD) are a common problem across medical settings and remain challenging to diagnose and treat. Many patients with FSD undergo sequential and unnecessary extensive diagnostic work-up, which is costly for society and stressful for patients. Previous studies have shown that the empirically based FSD diagnostic entities are interrater reliable and stable over time.

Objective
The aim of this study was to investigate whether internists who have received adequate training and with sufficient time per patient could diagnose FSD.

Design
This was a prospective diagnostic accuracy study. The study was conducted from May 2020 to April 2022.

Participants
The study included 27 consecutive patients referred by their general practitioner to a non-psychiatric diagnostic clinic for assessment of physical symptoms on suspicion of FSD.

Interventions
The internists received a 30-hour training course in the use of a tailored version of the SCAN interview.

Main measures
The main outcome measure was the agreement between the diagnoses of the internists and the reference diagnoses made by specialists in FSD on the basis of the full SCAN interview.

Key results
The interrater agreement between the internists and the FSD experts was substantial for any FSD (kappa = 0.63) as well as multi-organ vs. single-organ FSD (kappa = 0.73), indicating good diagnostic agreement.

Conclusions
Internists with proper training and sufficient time (3–4 hours) per patient can proficiently diagnose FSD employing a tailored version of the SCAN interview for use in a non-psychiatric diagnostic setting.

Open access, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307057
 
An internist getting 3 to 4 hours to diagnose a FSD?
After ME/CFS was mentioned I stopped reading. This junk gives me the shivers.
Everything that the internist can't find must be FSD. And the call themselves scientists?
Start learing about ME/CFS so you can diagnose it properly.
Just a few years ago I saw an internist, he talked about CPET, mine was 15 years ago, but didn't order even one. He talked about a 24-hour urine test(mine was last century) but didn't order one. CPET and urine test before I had to pay for myself, even though I was well-insured.
I showed CPET, tilt-table test, cognitive test and no NK-cell reactivity , CD4 CD8 and still I was not seen properly. Just seen as ME/CFS = FSD. No need for proper testing.
:banghead::banghead::banghead:
In stead of moonlighting in BPS they should become better at their current day-job.
 
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The full saying is "a few bad apples corrupt the whole bunch". Most people forget the last part. It's usually said when the bad apples are still very much in their same position of influence, negating the entire defense that it was "just a few bad apples".

This is the bad apples corrupting the whole bunch. It's creeping delusional pseudoscience everywhere as fully equivalent to the scientific method, making fallible human judgment equivalent to objective, repeatable predictive technology. Cutting edge science and delusional nonsense from the same position of authority make that authority unreliable and no longer credible.

It's also easy to train, let's go with internists for consistency, to read palms and diagnose spiritual crises, perhaps with astrological causes, as critical factors in illness. Or whatever. You can even show that they can do just as "well" as any fully trained, uh, palm reader / master astrologer. They will consistently have roughly the same generic ideas, since they are built like this.

And all you've managed to do is bring down real expertise to the level of cheap pseudoscience. It makes a mockery of the entire purpose of medicine, as fully as secret show trials with no due process make a mockery of a justice system.

But while attorneys would openly revolt at such things in a free society, here physicians rejoice and fuel it. It's all very disturbing.
 
Literal first line and para (my line spacing) in the introduction

"Functional Somatic Disorders (FSDs) are common across medical settings [1], and recent studies have found a high prevalence of FSD (8–10%) in the general population [2, 3].

Patients with FSD predominantly present in non-psychiatric settings with multiple physical symptoms that may mimic various other physical diseases and therefore present complex differential diagnostic dilemmas.

Furthermore, patients with FSD may also have physical and mental comorbidities, which increases the complexity of the diagnostic evaluation.

Many patients with undiagnosed FSD are repeatedly referred for diagnostic evaluation by various specialists, leading to overutilization of diagnostic and treatment resources [4–6].

Thus, some of these patients may be on a seemingly endless “odyssey” of repeated referrals for diagnostic evaluation in subspecialty clinics for years"


Talk about propaganda-like, 'watch out for the 1 in 10'

A wide range of terms have been employed to denote these disorders, such as medically unexplained symptoms, somatoform disorders, and functional somatic syndromes (FSS), including fibromyalgia, irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS) /myalgic encephalopathy (ME), and multiple chemical sensitivity (MCS) [8, 9]. Based on empirical research, and equivalent to the bodily distress syndrome (BDS) research diagnosis, a functional somatic disorder phenotype has been identified [9].
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Chilling. It is basically naming all of these as 'denoting this' ... when they don't - which should lead to them being sued in my book.

General practitioners find that this patient group is among the most difficult to manage [11–14]. Many patients with undiagnosed FSD are repeatedly referred for specialized diagnostic evaluation, leading to consternation among some clinicians [4, 15, 16]. From a societal perspective, the FSD patient group is overly costly due to excess use of medical care, lower labor market participation, and lost working years [17].
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In Denmark, the Danish Health Authority (Sundhedsstyrelsen) has mandated that FSD cases of mild and moderate severity should be managed in primary care, and only severe FSD cases should be managed at specialized FSD clinics [18]. This implies that most FSD patients have to be diagnosed and treated in primary care with the support of FSD specialists.
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Since 2008, all trainee General Practitioners (GPs) in Western Denmark have received basic training in diagnosing FSD and communicating/negotiating the diagnosis with FSD patients using The Extended Reattribution and Management (TERM) model [16, 19]. However, many GPs feel inadequate in managing the more complicated cases, especially at the early stage where the diagnosis is still uncertain and physical differential diagnoses have not been excluded.
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So the problem apparently is that GPs even with this dodge training are 'not confident' where there might be physical differential diagnoses - weird given the list of physical diagnoses are things they are trying to claim 'are' FSD falsely/inaccurately and say they are all 'equivalent to bodily distress syndrome'

Nope. this seems nothing short of propaganda.

And is shocking in in what it is trying to instate?
 
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"In total, 27 consecutive patients from the intervention group of the DISTRESS Trial were invited to participate in Gold standard interviews. The median age of the 27 participants was 34 years (range 18–64) and 23 of the participants (85%) were female. All 27 agreed to participate, and hence all 27 participants completed interviews by both an internist and the FSD specialist"
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"The results of the comparison of the 27 gold standard interviews with the primary SCAN interviews by the internists are shown in Table 2. The FSD specialist found that 24 out of 27 patients assessed had any FSD (positive rate 0.89), and 16 out of 23 patients with any FSD as rated by both the Internist and the FSD specialist had multi-organ FSD (positive rate 0.70)."
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Am I being cynical in assuming - given 23 are female anyway, so only 4 could be the men, but also:

At the 1st diagnostic level of classification of any FSD vs. no FSD, the internists were very good at “detecting” FSD and quite good at “ruling out” FSD, having missed only one positive and one negative of the 27 patient cases compared with the gold standard interviews by the FSD specialist.
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Which points to me like potentially using the heuristic of 'all women have it' ("were very good at “detecting” FSD") ie 23 means they 'missed one' of the 24 the 'FSD specialist' claimed to spot, and didn't spot one who actually had something else ("and quite good at “ruling out” FSD").

Isn't just being 'quite good' at 'ruling out' a major failure unless you are trying to train people to misdiagnose and bucket people? so don't really care as long are they are 'very good' at 'detecting'?

Just like they 'don't like to talk about harm' because they've wangled an area of medicine that somehow doesn't legally have to report it and use yellow cards so why would that type care?

But yeah @Turtle selling it as 'just 3-4hrs as an interview to diagnose' even when it was 23 out of 27 being female, so potentially whoever those who apparently fit the questionnaire criteria were it might have - if you were only going off 'did you get em all' instead of 'it is really important that you catch the 4 who don't and any more who don't' means the whole thing was a pure joke.

and they've pretty much confirmed even they see the term 'gold standard' as just a pat on the head badge for encouraging potentially misogyny and definitely potentially disability bigotries concealed under weaponising mental health with fake mental health.

SO as far as these people are concerned the penalty for lets be honest females with an average age of 34 who develop pains or disturbing symptoms of any kind, or who have a disease which these guys decided 'they don't approve of' ... because they are deluded... is to be targeted with what really isn't concealed at all by them attempting to weaponise those who work in the real health system and do real jobs by using nasty sales pitches to brainwash them ?

I wonder who is the waste of money problem really in the world?
 
bobbler said:
Am I being cynical in assuming - given 23 are female anyway, so only 4 could be the men, but also
But yeah @Turtle selling it as 'just 3-4hrs as an interview to diagnose' even when it was 23 out of 27 being female, so potentially whoever those who apparently fit the questionnaire criteria were it might have - if you were only going off 'did you get em all' instead of 'it is really important that you catch the 4 who don't and any more who don't' means the whole thing was a pure joke.


To clear up my reference. I was never given 3 - 4 hours by an internist doing his own job.
The diagnose FSD was made from the referral letter mentioning ME/CFS, before he even saw me. Being female only confirmed that prejudice.
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I even filed a complaint in the hope to get some testing done, to no avail. (my first official complaint)
Just after the complaint procedure I found out the same hospital had received 4,4 million to do bio-medical research on the severe multi-system disease ME/CFS, and Prof. Rosmalen heading that part.
3 highly trained doctors (internist, the chronic fatigue "specialist", his boss and the professor) had just told me to get stuffed, drop dead.
 
From a societal perspective, the FSD patient group is overly costly due to excess use of medical care, lower labor market participation, and lost working years [17].
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As I use in my signature: good research takes time, and is expensive, bad research takes forever, and is even more expensive. Had the necessary, expensive, work been done back then, it would already have paid for itself. Hell, that's not even fair, it would have generated far more income, huge ROI. Just as if we'd have heavily invested in renewable energy, we wouldn't be dealing with the consequences and the world would be both richer and healthier for it.

Which makes the idea of expanding the bad research extremely delusional in that its primary concern is reducing costs, while it does the exact opposite, while discrediting medicine with their fanatical obsession with pseudoscience. They built this mountain of lies that causes needless harm and suffering and is extremely expensive, they hate the outcomes, and they forever want more of it. We'd be better served with a committee of dogs wagging their tails to set priorities here.

Plus the committee of dogs would be cute and friendly, unlike a committee of Finks.
 
rvallee said:
As I use in my signature: good research takes time, and is expensive, bad research takes forever, and is even more expensive. Had the necessary, expensive, work been done back then, it would already have paid for itself. Hell, that's not even fair, it would have generated far more income, huge ROI. Just as if we'd have heavily invested in renewable energy, we wouldn't be dealing with the consequences and the world would be both richer and healthier for it.

Which makes the idea of expanding the bad research extremely delusional in that its primary concern is reducing costs, while it does the exact opposite, while discrediting medicine with their fanatical obsession with pseudoscience. They built this mountain of lies that causes needless harm and suffering and is extremely expensive, they hate the outcomes, and they forever want more of it. We'd be better served with a committee of dogs wagging their tails to set priorities here.

Plus the committee of dogs would be cute and friendly, unlike a committee of Finks.
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Yep. Agree. Of course the issue I suspect is the professions lack of willingness to remove the toy from an old guard. As we see with the BACME stuff. So I agree 100% but I think there is an issue with removing the people involved from the power they collected, it turns out based on results that never came.

I think of things like IAPT's long term conditions 'treatment' getting sold to CCGs in the past telling overworked GPs the lie that those with 'MUS' generate 'loads of their appointments' aka 'are why you are overworked' to sell the fake promise that their offering was 'cheap at any cost'. Well once some poor vulnerable (or not) person has been hoodwinked and repeated that when they make said decisions then they are 'in on it'.

So they can't go back to their peers saying it turned out to be rubbish, although the idea of a CCG having GPs on it was for exactly that pragmatism. Is there something in said positions needing to rotate and not be the same person assessing 'did it work' as who sold the decision of 'choosing to try/fund it'? Or even better it becomes a different position where proper science training via Nice to be able to assess proper clinical thresholds of significance rather than statistical ones and so on be part of such positions and decision-making?


Currently I get the impression it is a long-term position based on hierarchy, but this is the catch.

I don't know how to put this analogy other than to underline that I'm making no inference at all about GPs and certainly not saying they are bad people or anything like these types.... but it makes me think of when you watch TV programmes and you hear of eg mafia or gangs or bad bosses using the tactic of conning someone new into doing something 'low level' and then they are 'part of it' or 'in on it' so they couldn't just report something because it would be themselves.

What I am saying therefore is that there has been enough line in the sand from enough water under the bridge to prove that having had the world to themselves where they could explore their BPS nonsense to their heart's content with all sorts of dodgy design and methods that would never have been allowed under normal regs, and under a culture where they only had to publish positive results, they found none. And after this much time, and that much 'special circumstances' for them I think that equates to 'your BPS ideas are proven to not work for ME/CFS', because you would have by now if it wasn't nonsense. PLus they never tested the null, by refusing to ever measure harm and pretendign 'no change' wasn't said null.

And because of that really dodge stuff going on well they've dragged too many into it for them to be able to assess it fairly. And even if you found those who could they've left the people we know might 'use their undue influence' where they are without protecting said people.
 
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