NHS Northumberland Tyne and Wear MUS

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Practical measures with your patients with medically unexplained ‘functional’ symptoms

pdf

https://www.cntw.nhs.uk/content/upl...ients-With-Medically-Unexplained-Symptoms.pdf

Common recognisable syndromes
•Fibromyalgia
•Irritable Bowel Syndrome
•Chronic Fatigue Syndrome
•Temporomandibular Joint (TMJ) dysfunction
•Atypical facial pain
•Non-Cardiac chest pain
•Hyperventilation
•Chronic Cough
•Loin Pain haematuria syndrome
•Functional Weakness / Movement Disorder
•Dissociative (Non-epileptic) Attacks
•Chronic pelvic pain/ Dysmenorrhoea
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Functions of somatisation
•Allows patient to occupy sick role while psychologically unwell
•Blame-avoidance – patient in role of victim
•Reducing blame minimises stigma for being emotionally unwell or ‘weak’
•The Doctor may become ‘blamed’ for not curing the patient
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quoted papers are really old
Clinical impact
•1 in 5 new consultations in primary care may be for somatic symptoms where no specific cause is found (Bridges, K.W. and Goldberg, D.P. (1985) Somatic Presentation of DSM-III Psychiatric Disorders in Primary Care. Journal of Psychosomatic Research 29:563-9)
•Up to 30% of primary care consultations no physical cause found for symptoms, rising to 52% in secondary care settings Nimnuan, C., Hotopf, M. and Wessely, S. (2001) Medically unexplained symptoms: an epidemiological study in seven specialities. Journal of Psychosomatic Research, 51: 361-7
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Consequences (Katon et al, 1984, 1991)
•Unnecessary and expensive lab tests
•Repeated hospitalisations
•Iatrogenic illnesses eg polysurgery
•Prescribed drug misuse
•Poor Dr-Patient relationship
•Secondary impact on family and social network
•Disability and loss of earnings
•Dependence on health care system for social support
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it just goes from bad to worse.

( previously posted by Dx Revision watch here
https://www.s4me.info/threads/iapt-...us-not-otherwise-specified.13691/#post-237539)

are the charities doing anything to get ME/CFS removed from MUS?
 
That seems to have been uploaded in 2016, so it is not the ancient history that it would appear to be, although iIcannot see a date of publication.It does seem to get something right, its pretty little theme Shining a light for the future .

There is no more appropriate expression than "shine a light".
 
The document expressly cites an NHS guideline from 2013. It can be assumed that the document was produced between 2013 and 2016.

It is interesting that they cite Katon et al 1984 and 1991. The 1984 paper was Depression: relationship to somatization and chronic medical illness.

It is just a pity that they did not quote his paper delivered at the 1985 illness behaviour conference, which would have provided a direct link to the fantasy world in which these ideas were formed.
 
TMJ seems a random one to throw in there for them. What do the dentists that often deal with that think of it?

But yes this comes across as poisonous diatribe from someone with a certain attitude towards certain types of people who has an axe to grind trying to justify it all. All very non-specific like a grab and make fit list of excuses - not so dissimilar to that ole list of causes of FND that basically suggested anyone who has been through a pandemic, had a childhood of some sort and either breaths or doesn't breath as being 'things to look out for as precipitating factors'.

Maybe we've got to the stage where these are best dealt with by some classy memes (if it weren't for the patients who currently appreciate the diagnosis) noting how their characteristics tend to be crowbarrable to cover any possible person e.g. 'anyone who liked Roland Rat back in the day is particularly susceptible', 'anyone who didn't like Roland Rat back in the day is particularly susceptible'. And suggest things that would almost deliberately elicit a peed off reaction in anyone who was awake.

Anyway they are clearly selling taking their medical degree at a time of severe shortage and instead using it to prevent ill people from accessing medicine on claims of 'we pay for ourselves in saved treatment costs'. As if the moment they disappear the hospital will be booked up with laparoscopies. Why is it that noone wants to study the evidence there? And work out whether if you took them off their pet whatever and put them full time on laparoscopies or wherever the work shortage is that their level of training could be repurposed to that would actually 'save more money' by reducing whichever waiting list and taking some work off the short-staffed?

My rule when presenting anything to academics from science backgrounds was always that whatever figures you give in a report, make sure the appendix shows the full table, workings and references - because they will assume they are being manipulated if not there, clear with lines highlighted and arrows so they can see origins for each calc. Why on earth does the medical profession take what seem ridiculous plucked out of thin air figures (because you don't get them from non-specific experiments or investigations so they must be contextualised) without these expecations - and yes the fact I see this happen so much in this area makes me assume noone checks claims of savings are actually accurate and true in the context they've inferred, and they know it.
 
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