Patient-Centered Medicine: A Necessary Condition for the Management of Functional Somatic Syndromes and Bodily Distress, 2021, Cathebras

This paper argues that “functional,” “medically unexplained,” or “somatoform” symptoms and disorders necessarily require a patient-centered approach from the clinicians. In the first part, I address the multiple causes of the patients' suffering and I analyze the unease of the doctors faced with these disorders. I emphasize the iatrogenic role of medical investigations and the frequent failure in attempting to reassure the patients. I stress the difficulties in finding the right terms and concepts, despite overabundant nosological categories, to give a full account of psychosomatic complexity. Finally, I discuss the moral dimension attached to assigning a symptom, at times arbitrarily, to a psychogenic origin. The following part presents a brief reminder of the patient-centered approach (PCA) in medicine. In the last part, I aim to explain why and how patient-centered medicine should be applied in the context of functional disorders. First, because PCA focuses on the patients' experience of illness rather than the disease from the medical point of view, which is, indeed, absent. Second, because PCA is the only way to avoid sterile attribution conflicts. Last, because PCA allows doctors and patients to collaboratively create plausible and non-stigmatizing explanations for the symptoms, which paves the way toward effective management.

Open access, https://www.frontiersin.org/articles/10.3389/fmed.2021.585495/full

 

Have doctors/reasearchers/psychologists/psychiatrists decided that psychosomatic and somatic now mean the same thing? Does "somatoform" mean the same thing as "somatic"?

 

We should research the claim that repeated medical investigation is the cause of somatization or somehow causes illness by suggesting to patients that they are ill.

 

What I object to is the phrase "patient-centred medicine". Medicine is never, in my experience, determined by the patient or centred on the patient, it is determined by economics and the opinions of doctors who have seen the patient before. It just needs one doctor to make a mistake in a diagnosis. That mistake is then welded to the patient for life, and determines all future relationships between the patient and doctors.

 

No surprise, coming from Cathébras. To my knowledge, he is the main advocate for functional somatic syndromes in France and has been at it for more than 30 years.

He has written an educational book titled "Functional disorders and somatization" (2006), and he contributed to a government-commissioned, fully BPS-oriented report on fibromyalgia (which he argues is a "social construct") by the National Institute of Health and Medical Research (INSERM) that came out last year.

He is a strident denier of ME/CFS, which he used to call "yuppie flu" in 1991. In 2016, following the IOM report, a general, BPS-oriented article on ME/CFS written by some of the internal medicine specialists on the national CFS association's scientific advisory board was published in the French Journal of Internal Medicine. He wrote a scathing reply in which he vilified ME/CFS patients as activists and recounted their "harassment" against Wessely.

In 2019, he also wrote an article in The Conversation against the diagnosis of chronic Lyme that pushed for the diagnosis of FSS... with an associate editor of the Journal of Psychosomatic Research, psychiatrist Cédric Lemogne.

While ME/CFS is not officially recognized in France, I am very concerned that he could be part of a committee on a report or on guidelines on ME/CFS if they were to be commissioned.

Otherwise, he is the head of the expert center for rare autoimmune and systematic diseases at the university hospital of Saint-Etienne (central-southern France).

 

Beyond parody. Medicine seriously needs to tackle the crisis of Dunning-Kruger in its midst. The people who are the most wrong are supremely confident in their incompetence. And in the end they basically commit all the psychological fallacies like it was a damn competition, and they are supremely confident that it's the other way around. Good grief the mediocrity.