King's Health Partners, "Medically Unexplained Symptoms A Practical Guide", March 2017

I will ensure they know this. 'Thank you' on their behalf.

 

More in relation to Jon Stone and ‘MUS’/’functional disorders’, by an anonymous advocate/self-confessed couch turnip. (I can attest that said advocate has more than their fair share of dna from north of the border so any Scots of a nervous disposition need not take offence ). This is a quirky post, but making interesting observations nevertheless. If you're wondering about the 'Balmoral' ref it relates to Prince Charles who apparently has a penchant for chatting to turnips.

********



QUESTION -

Q. When is a turnip not a turnip?


- Quite a philosophical debate perhaps, and one that Jon Stone and Alan Carson prompted with this recent article http://pn.bmj.com/content/17/5/417 entitled “‘Organic’ and ‘non-organic’: a tale of two turnips” published in ‘Practical Neurology’, a BMJ journal, first in May 2017 and then a later version in June 2017 (see various incarnations at this link: http://pn.bmj.com/content/early/2017/05/16/practneurol-2017-001660)

A version of this article is available to read here - Non-Organic - Edinburgh Research Explorer (https://tinyurl.com/ybeqkr8d )


The thrust of this short article seems to be that the authors are taking issue with the Oxford English Dictionary’s definition of the word ‘organic’ because it states or implies that the opposite of ‘organic’ is ‘functional’, (and also adds that ‘organic’ is ‘not psychogenic’).

They argue that the opposite of ‘organic’ isn’t ‘functional’ but ‘non-organic’ or ‘in-organic’, i.e. not relating to living things, and as such these latter two words cannot have a place in their specialty of neurology. Rather than being the opposite of ‘organic’, they seem to infer that 'functional' is a sub-set of it.

But they go on to say that they don’t like the word ‘organic’ either, (although they admit to having used it repeatedly in the past), because it has previously been used to describe things pertaining to organs and to exclude problems of a ‘functional’ or ‘psychological’ nature.

They don’t seem to propose any words to use instead of it, but hey ho.

They conclude with a picture of two 'organic' turnips to make the point that 'non-organic' turnips don't exist.


Let us suppose that turnips could be their analogy for patients here...... an interesting choice – a Scottish version of couch potatoes perhaps?

Presumably they would regard their patients then as 100% organic with no inorganic component whatsoever. That’s good news, isn’t it? Patient complaints must then fall into one of two turnip categories - either definitely 'organic', as revealed by tests/investigations, or 'functional', when tests/investigations fail to reveal their 'organic' basis due to current lack of knowledge. Either way they are all 'organic' at heart. NB I’d personally choose the word ’biomedical’ over ‘organic’, I’m not sure why they haven’t suggested it.

Note that I haven’t mentioned ‘psychological’ with ‘functional’ here. In this presentation on his neurosymptoms.org website http://www.neurosymptoms.org/ Jon Stone makes the case that he doesn’t think that ‘functional’ disorders are ‘in the mind’, but rather that in his own specialty of neurology they are caused by problems with how the nervous system works, a sort of 'software' problem, inferring that we haven’t yet managed to elucidate their cause. (With my science background, in this context 'software' conjures up images of biochemical pathways, ones that are presumably yet to be discovered and tests developed for.) Dr Stone comes across in this presentation as being very sympathetic towards patients with these disorders, which must surely be a good thing, and he repeatedly talks about the stigma associated with these diagnoses and the need to address that. But in one place he does perhaps slip up a little by including the word ‘only’ in relation to patients having such a disorder (at 4.30 to 5.00 mins), so maybe ‘functional’ disorders aren’t quite as serious or as interesting or as worthy of treatment, resources and sympathy to him as true ‘organic’ illnesses after all?

Perhaps I’m being overly cynical/unfair though, maybe he truly wants to help these patients and devote his skills and time to curing them. But if so, wouldn’t he now have a very loud voice shouting out against what is being rolled out with respect to MUS in the UK?

To return to the original question

Q. When is a turnip not a turnip?

A. When it is sent for IAPT cognitive behaviour therapy (CBT), in order to make massive NHS cuts and savings, instead of being properly investigated and/or included in carefully conducted biomedical research trials to elucidate the ‘organic’ cause of its symptoms.


“Ah”, some might say, “but these psychological therapies are the only treatments we have at the moment, we don’t have other treatments for these poor patients, we need to give them something, it would be cruel not to”.

Perhaps then these turnips have another component to them after all, a non-organic psychological one that responds well to being talked to? And perhaps IF Dr Stone truly believes, (because this is an unproven belief), that talking therapies can alter ‘organic’ diseases, then he may like to take a day trip from Edinburgh to Balmoral Castle to talk to any ailing turnip plants that are struggling to flourish in the vegetable garden there?

I would, of cause, acknowledge that turnips, as far as I’m aware, don’t have much of a biological capacity for ‘fight or flight’ when they perceive danger (or Dr Stone approaching), their stressors affect them more directly and there’s unfortunately not an awful lot they can do about it. But can we really be so arrogant to believe that we humans have reached such a high plain in evolutionary terms that psychological stress can explain persistent/chronic illness with physical symptoms not subsiding when the transient stressor has ended? Where is the evidence for this? How can one person suffer all these symptoms supposedly due to stress whilst another who experiences the exact same stressors is absolutely fine? This can surely only be explained by the sufferer not having adequate biology to cope, being biologically compromised, not fit for purpose, biomedically ill. Treating patients psychologically for any apparent stress in their lives is, at best, just tinkering around the edges because it is the biological system that is defective, not a psychological one, and resources should be targeted at researching all the potential biological causes, instead of ignoring them.

So rather than heading for Balmoral, (or his next clinic), Dr. Stone could make a real stand, put his money where his mouth is, or vice versa, speak out about this appalling unevidenced (and not risk-assessed) waste of NHS money and lobby for good biomedical research into all these so-called ‘functional’ disorders instead.

 

More on Muj Hussain.

Apart from producing the presentation on this thread he is involved in the upcoming RCPsych European Division Spring Conference 2018 in Dublin entitled "TAKING PSYCHIATRY FORWARD"- RCPsych European Division Spring Conference 2018 16th March ... - in the last session of the afternoon - a Liaison Psychiatry interactive workshop.

In the same session, Professor George Ikkos presumably enlightens workshop participants about the new Stanmore Nursing Assessment of Psychological Status instrument to be used to "enhance good emotional care" of inpatients. They've tried it out on spinal cord injury patients - https://www.ncbi.nlm.nih.gov/pubmed/27077577 - but I imagine that their intending to roll it out for use with lots of inpatients in lots of specialties, (if it hasn't been already). https://www.ncbi.nlm.nih.gov/pubmed/29182036


Nice perhaps that they'd think of the emotional wellbeing of patients, a shame that they just can't get away from their fixation on 'healthcare utilization' - https://www.futuremedicine.com/doi/abs/10.2217/pmt-2017-0045?journalCode=pmt. It's all about the money in the end. Can't these doctors ever stick to their day jobs and leave the health economics to the economists and politicians?

 

Trying to extrapolate the total number of appointments and patients using this logic 10% would be double the 21 765 not half.

 

Not sure what you mean here.

To say it another way round:

If these patients make up just 10% of the appointments (instead of the 20% plus that they claim they do) then we would expect the total number of appointments to be 4,335 x 10 = 43,350. This equates to 43,350/115 GP weeks = 377 GP weeks or approximately the workload for 8 GPs. These 8 GPs look after 13,038 patients so their list size is now just over 1,600, what you would expect to see.

So it looks like these patients do in fact make up 10% max of the appointments, NOT the 20% plus that they claim in the presentation to be MUS patients .

 

https://www.hee.nhs.uk/sites/defaul...rces for High Intensity Therapist courses.pdf

I thought I got the above link from this thread, but can't see it now. Guide for IAPT promoting CBT/GET for CFS, using PACE manulas and the Lancet PACE paper as the only supporting evidence.