Hasn't it been shown that surveys of, well actually all specialists, show that actually they don't? Most reject referrals for this, this is something that would be easily knowable, if there was motivation to organize that information. Which there isn't. Because it's embarrassing, and not knowing helps cover it up. Funny how that works. But there are surveys of MDs. What is the point of people doing those surveys if their findings simply never get used?
That was actually something kinda funny/tragic, maybe I'm remembering wrong but there was a survey of neurologists about FND and most didn't even want to see any of those patients, because they understand what all the dog whistles mean and don't take it seriously. And it was done by some of the big FND promoters who concluded, as usual, that they need to tune their patient dog whistles better, as if it changes anything for MDs who know that it all means, uh, who even knows at this point.
Anyway, this is comically wrong. Of course they don't, because of decades of BS pseudoscience there's hardly anything they know to do anyway, even though there are probably things that could help, but it's all washed up in a sea of pseudoscience obsessing over the magical effects of exercise. Somehow just recreational exercise, oddly enough, in people who are doing generally well. And similar to other recreational things, including sedentary activities, in people who are generally well. Funny how that works, people enjoy to do things they enjoy if they can enjoy them, and if they can't, because they're ill, but you don't believe it, then figure out how to get them to say it anyway, even if it's false, especially if it's false.
I note that the GP stuff gets targeted in the UK, particularly more so in recent decades, because they are independent from NHS (but not from the colleges) and gatekeep (both patients and funding to hospital depts and tests) and if influenced can then influence funds to almost everything directly and indirectly. It is very different to the set-up and result you would see from eg the market-driven situation of USA, or even a health system where there was a different central point for diagnostics and collecting information on what people
actually have and then planning from there.
It would be a fascinating one for someone to put/explain better but it is a really weird and vulnerable to influence and conflict of interest model when you think about the vast power within that if someone influences it.
- GPs in the UK
aren't employees of the NHS (but instead their GP surgery) and each GP surgery is a business in its own right (so x number of the GPs there are partners taking dividends instead and having 'other roles' related to the business) with those in charge of funding instead using 'nudges' like incentives such as certain things 'costing money' and others 'being part of the KPIs by which you earn money' (like x% of those with asthma having a review once a year, x% of those you deem as 'depressed' being given a card for IAPT was one in the past).
Apparently being a partner is a massive job re: hours, which means even those who perhaps have all the best of intentions are spread so thin they are very vulnerable to not having the mindspace to criticically think on or question when edicts from those who've gone into positions suggesting these things to them are put out there, sold with 'will solve x problem for you'.
One of the main jobs of these businesses is managing the costs of peoples healthcare and prescriptions, and delivery of things like vaccines they might get paid a contract etc. The local boards which used to be CCGs would have GPs on them deciding where funds were spent apparently 'based on demand/need' but tail wags dog there (you can't send a 1000 people needing rheumatology to a closed list so they all went to physio that then 'seems to have the demand')
Lots of GP surgeries (which group together often and commercial groups have come in to take over many of these) now have in recent years added the following, which I assumed are funded initiatives (but I assume will be based on targets so said staff aren't sitting around): their own on-site physios, psych-related staff, pharmacist, maybe OT, maybe wellness 'coaches' type staff etc.
Local boards can also decline referrals or requests for scans, and 'lists' can be closed which leads to tail-wags-dog diagnoses based on what they
can test or where they
can refer to. Instead of 'you probably have a head injury but I'm sending you to IAPT (for CBT.. because they’ve got loads of space and if I refer you for a head scan or appt in a hospital dept it will be declined as the list is closed due to not enough supply vs demand)' you can imagine what might happen.
The circle gets squared in the diagnostic description. People are sending you somewhere rather than nowhere ‘to help’ and the better that salesperson can be with a spiel to heal that cognitive dissonance cfs professional instincts then it sorts tgat short term problem- whilst making it ten times worse long term by shifting funding and perceived demand for different specialties more permanently. So instant of urgent need for more scanners and supply of people who deal with head injuries so appointments are available and in good time, it goes down as IAPt demand really high in next funding round.
But also the GPs have literal pathways on their computer screen that they have to click through and follow. Which is what I assume is behind the ulcer ridiculousness (you have barn door ulcer symptoms, but we have to follow this so: go away for 2weeks and see if it gets better, then another 2 weeks whilst being told you are stressed and so on).
