Improving teaching about medically unexplained symptoms for newly qualified doctors in the UK - Yon et al 2017

Sly Saint · Aug 20, 2020

Improving teaching about medically unexplained symptoms for newly qualified doctors in the UK: findings from a questionnaire survey and expert workshop

Abstract
Objectives Medically unexplained symptoms (MUS) present frequently in healthcare, can be complex and frustrating for clinicians and patients and are often associated with overinvestigation and significant costs. Doctors need to be aware of appropriate management strategies for such patients early in their training. A previous qualitative study with foundation year doctors (junior doctors in their first 2 years postqualification) indicated significant lack of knowledge about this topic and appropriate management strategies. This study reviewed whether, and in what format, UK foundation training programmes for newly qualified doctors include any teaching about MUS and sought recommendations for further development of such training.

Design Mixed-methods design comprising a web-based questionnaire survey and an expert consultation workshop.

Setting Nineteen foundation schools in England, Wales and Northern Ireland

Participants Questionnaire administered via email to 155 foundation training programme directors (FTPDs) attached to the 19 foundation schools, followed by an expert consultation workshop attended by 13 medical educationalists, FTPDs and junior doctors.

Results The 53/155 (34.2%) FTPDs responding to the questionnaire represented 15 of the 19 foundation schools, but only 6/53 (11%) reported any current formal teaching about MUS within their programmes. However, most recognised the importance of providing such teaching, suggesting 2–3 hours per year. All those attending the expert consultation workshop recommended case-based discussions, role-play and the use of videos to illustrate positive and negative examples of doctor–patient interactions as educational methods of choice. Educational sessions should cover the skills needed to provide appropriate explanations for patients’ symptoms as well as avoid unnecessary investigations, and providing information about suitable treatment options.

Conclusions There is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
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https://bmjopen.bmj.com/content/7/4/e014720

I picked up on this from article in this thread
https://www.s4me.info/threads/a-two-part-article-from-goodelf-on-mus.16373/
part 2

Katherine Yon went on to train to become a clinical psychologist and has written journal papers about MUS. In this 2017 paper3 she and her co-authors admit that the treatment model for MUS has no evidence of clinical effectiveness and yet they suggest expanding the teaching of this model to junior doctors.
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as far as I can find this is the relevant bit in the paper

It is important to highlight that, although specific management techniques have been recommended in our paper and in the literature, there is currently only clear evidence for their effectiveness in improving clinician skills when communicating with patients with MUS22 and reducing investigations and healthcare costs.20 An educational intervention focusing on these areas is likely to produce tangible benefits in terms of reduced frustration for both patients and clinicians, increased patient satisfaction and reduced costs. The evidence for a direct impact on clinical outcomes such as improved mood, functioning or quality of life is still lacking and any formal evaluation of a new educational intervention would need to carefully assess these factors.
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Cheshire · Aug 20, 2020

How can this category still be a thing? The MUS concept is so absurd.

(Sorry, I know this is obvious for anyone, just needed to vent )

Peter Trewhitt · Aug 20, 2020

Is no training better than providing misinformation?

NelliePledge · Aug 20, 2020

Yes @Peter Trewhitt as soon as I saw the title I thought best improvement would be stop the training, get rid of it altogether.

Arnie Pye · Aug 20, 2020

Conclusions There is an urgent need to improve foundation level training about MUS, as current provision is very limited. An interactive approach covering a range of topics is recommended, but must be delivered within a realistic time frame for the curriculum.
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Got to get those baby doctors brainwashed at the earliest opportunity!

After all, doctors need an officially approved way of hiding and disguising their lack of skill in diagnosing anything.

Peter Trewhitt · Aug 20, 2020

The ME Association, the UK all party Parliamentary group and the Scottish Parliament are doing some good work looking at Doctor/GP training in relation to ME, but so much needs doing.

Also @PhysiosforME are doing important work towards training Physios.

But in terms of MUS the battle for the soul of modern medicine still needs to be waged.

dave30th · Aug 20, 2020

My concern is that the forces will retreat from ME specifically but get their arms around MUS overall so it's a tactical loss but a strategic gain in the end.

rvallee · Aug 20, 2020

are often associated with overinvestigation and significant costs
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They're just blatantly going to lie like that?

The real costs are the indirect economic losses from lying about sick people and abandoning them with no help or support, are massively larger than the poor state of medical care misused on us and are a direct product of this ideological nonsense pushing disinformation about things they know nothing about and are making up entirely out of their ass.

Improve this "teaching" by burning your medical license and never subjecting human being to your complete lack of judgment. These people would be all about the humors and other nonsense in another time, would have rejected the germ theory of disease as farcical. No human life should ever be determined by such mediocre misleading nonsense, let alone completely ruined by it. This is no different than arbitrarily dishing out life sentences over someone's astrological sign, completely immoral criminal negligence.

Hutan · Aug 21, 2020

Cheshire said: ↑

How can this category still be a thing? The MUS concept is so absurd.
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Yep

Medically unexplained symptoms (MUS) present frequently in healthcare
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Educational sessions should cover the skills needed to provide appropriate explanations for patients’ symptoms as well as avoid unnecessary investigations, and providing information about suitable treatment options.
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So, the suggestion is that doctors should respond to a medically unexplained symptom with 'appropriate explanations'. But, if there was a well-founded, evidence-based explanation for the report of the symptom, then it's either not a 'medically unexplained symptom' or the patient has just made the symptom up.

An educational intervention focusing on these areas is likely to produce tangible benefits in terms of reduced frustration for both patients and clinicians
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Umm, I don't think so.

Sean · Aug 21, 2020

rvallee said: ↑

No human life should ever be determined by such mediocre misleading nonsense, let alone completely ruined by it.
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Probably best then that you don't read too many history books, because that is the historically 'normal' situation across the board. Not just in psych or medicine.

Hutan said: ↑

An educational intervention focusing on these areas is likely to produce tangible benefits in terms of reduced frustration for both patients and clinicians
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Umm, I don't think so.
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Yeah, that ain't gonna work. Not even for the medicos.

alktipping · Aug 22, 2020

would all of this nonsense have gotten any traction if patients had a way to deny bad or lazy doctors any income .It seems this whole field is about giving doctors the excuse to both save money and their time whilst acting as a salve to their ego

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