Earlier in 2005, another Stone, Carson and Sharpe paper/article had been published –
https://www.acnr.co.uk/acnr%20jan%20feb%202005.pdf – in which they’d cited Nimnuan et al 2001 as evidence for high MUS/’functional symptoms’ prevalence rates in neurology. They claimed that Slater had been wrong about misdiagnosis, and that the rate of misdiagnosing neurological patients with functional neurological disorders in more recent times had been ‘consistently’ below 10%. Don’t they know what ‘consistently’ means? It seems that these authors will reference the Nimnuan et al study when it suits them to evidence high MUS/functional disorder prevalence rates in neurology but will ignore its other findings when they’re discussing and reviewing misdiagnosis rates.
Their 2005 systematic review has been used to persuade and reassure doctors that they need not be overly concerned about the risk of misdiagnosis, and not only in neurology clinics but when labelling their patients with ‘MUS’ in any specialty. It was included as a reference in the RCPsych/RCGP’s 2011 “Guidance for health professionals on medically unexplained symptoms” – [available here on registering –
https://www.scie-socialcareonline.org.uk/…/a11G00000017xGwI… ] – to evidence that 4% to 10% of ‘MUS’ patients have their symptoms re-diagnosed as an ‘organic’ condition. Readers weren’t told about the high misdiagnosis rates of the Nimnuan et al 2000 paper, even though the paper was cited in the same section as evidence of high MUS prevalence rates! The same low 4% to 10% MUS misdiagnosis figure was also included on page 7 of this 2018 Paediatric Mental Health Association (PMHA)/ RCPsych guidance on MUS for pediatricians and other doctors –
https://paedmhassoc.files.wordpress.com/…/mus-guide-with-le… but the reference given was not the original review paper but the 2011 MUS guidance (discussed above) that had cited it. Paediatricians weren’t warned about the high misdiagnosis rates found in a key MUS study and weren’t advised to proceed to more complex investigations if basic investigations were negative.
Astonishingly, it seems that Stone, Carson, Warlow and Sharpe were concerned that their systematic review of misdiagnosis rates may not have been up to the mark years before those two guidance documents on MUS were published. In 2009 they reported on a newer study of misdiagnosis rates –
https://academic.oup.com/brain/article/132/10/2878/333395 , advancing their lack of full confidence in their review’s conclusion as a reason for conducting the new study. (From the 2009 paper it looks as if they may have decided that their systematic review wasn’t good enough even before the review was published!) Do they know that their shaky review has been used since as evidence to persuade doctors that MUS misdiagnosis rates are quite low? If so, then don’t they have a duty as doctors to point out its shortcomings to the medical community? Perhaps they’ve done this somewhere, but the very next article in that 2009 journal was a paper by Wessely and others –
https://academic.oup.com/brain/article/132/10/2889/328088 – in which the Stone et al 2005 review is referenced as evidence that ‘organic’ explanations can be ‘effectively’ ruled out. The paper opens with Nimnuan et al 2001 again being cited as evidence for high MUS prevalence rates (supposedly making up 30–60% of neurological referrals) but there’s no mention of that study’s 19% (or 21.1%) MUS misdiagnosis rate for neurology that, going by the Stone et al 2005 review paper, would be considered unacceptably high. What excuse is there for Wessely not mentioning those accompanying high MUS misdiagnosis rates?
