Trial By Error: The Cost of MUS

In a time where profit maximization is everything, the best argument in my view is to point out that something isn't cost-efficient. The health system is classified as an industry, namely as part of services industries. Principles known from production, e.g. production lines, are translated to the health system. All the problems with that have been pointed out many times, and I think to most people it is intiutive that a hospital is not a car production line. But that's how it is. (I obviously don't agree with that approach.) It doesn't matter if sth. is correct, it's about politics and money.

In case of MUS, obviously the numbers are worse than propagated, and pointing this out - showing there is a more cost-efficient alternative - might change sth.
 
Jonathan Edwards said:
The whole business about trying to make health care 100% efficient is worth some thought. We know that 100% bed occupancy in hospital sis dangerous but I suspect people do not realise just how essential 'inefficiency' is to good health care.
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The bean counters invariably gloss over / ignore / don't want to see the hidden costs, because it doesn't look good to their masters. Real, worthwhile efficiency measures cannot ignore hidden costs, but they get ignored, and then they wonder why it all goes wrong. But the one thing they always know for certain, is that it is never their fault.
 
Jonathan Edwards said:
The whole business about trying to make health care 100% efficient is worth some thought. We know that 100% bed occupancy in hospital sis dangerous but I suspect people do not realise just how essential 'inefficiency' is to good health care.
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I agree but voters won't

The idea of a doctor is someone who is likely to know whether or not you are really ill when you, as a lay person may not. Recognising signs of disease is an art that takes 10 years training. So it is reasonable to assume that the lay person will be looking after their health properly if they go to the doctor three times as often as they have serious disease. So we want a system that is 75% 'inefficient' in terms of there being something seriously wrong every time someone goes to the doctor.

Those 75% of times may often be for symptoms with no medical explanation of importance. So in a sense we are expecting 75% of resources at least in diagnostic terms to be 'wasted' if we want adequate health care. And of course that does not in any way imply that these unexplained symptoms then need to be dealt with by some mumbo-jumbo therapists. The person just needs to be told that nothing serious has been found.

What I find most worrying is that the RCGP has bought in to this 'efficiency' approach wholesale.
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When you want votes you don't explain how the real world works because few want to hear it, you provide easy answers and rally against any enemy you can invent.
This kind of nuance is too complicated, simple but wrong wins the day because easy answers are more convincing to the masses then a nuanced yet easily provable truth. Consequences often change things but a short time later people forget those lessons and go back to the easy answers.
So the Psychosomatic crowd is basically using this playbook, plus their bullying tactics to prevent dissent. Their house of cards will eventually crash but their goal is to prevent this by any means necessary.
 
Medically unexplained doesn't mean medically unexplainable. Just because medical science doesn't yet understand something, it doesn't mean it's imaginary. There is a certain arrogance amongst these "professors" of medicine (many of whom are clinicians with a few crappy published papers and only have an undergraduate degree in medicine and no PhD and thus know jack shit about science) that the human brain somehow has inherent capacity to grasp infinitely complex issues. We may never understand the mysteries of the universe (or all the intricacies of the human body) because it may be beyond the comprehension of our pea brain but that doesn't mean the universe is psychosomatic.
 
Stewart said:
@dave30thThe Department of Health's 2008 Departmental Report gave the NHS financial settlement for 2008/9 as being £97.1 billion (Page 148, Figure 9.5). So £2.89bn would be less than 3% (2.98% to be more precise) of the total NHS budget for that year. The 10% figure that Professor Chew-Graham is so fond of is more than a threefold exaggeration of the actual spending on MUS as a percentage of the total NHS budget for that year
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Thanks for looking this up.

Important to remember that Bermingham et al. calculate the “somatisation-specific costs among working age population in England 2008-2009” as £2.892 billion. So when they say, “This represents approximately 10% of total NHS expenditure on these services for the working-age population in 2008–2009,” they could be referring to the total NHS expenditure on “these services” in England, rather than the UK as a whole. Reading the paper quickly, there seems to be some ambiguity and a lack of references for some of the figures.

The paper also seems to assume that MUS is synonymous with “somatisation”. But if somatisation explains the symptoms, how can they be considered unexplained? Is this an unintended admission that somatisation isn’t a real explanation for anything?

Another thing which struck me was that the definition of MUS seems to be very broad, including self-harm, sexual dysfunction, self-esteem issues, and “medically unexplained decline” in cancer patients – perhaps because it was deemed expedient to make the cost of MUS look as high as possible – but there is no mention of ME/CFS, chronic fatigue or even fatigue, as there has been in other literature about MUS. I wonder why that might be.

Also, in the intro, the authors write, “Nor is somatisation a modern phenomenon in the illness experience. Over 2000 years ago Galen noted that 60% of people visiting a doctor suffered from symptoms that had emotional rather than physical causes.” Interesting reference given how poorly understood nearly all diseases were at that time and how many were wrongly attributed to hysteria, somatisation or other such nonsense. Another unintended admission of how outdated and unhelpful the concept of somatisation is?

It is worth noting that, according to livescience.com, Galen’s text On Affected Parts suggests that “women became hysterical, and could suffer from ‘hysterical suffocation,’ or apnea, when they stopped having intercourse. The condition could make them ‘apnoic, suffocated or spastic’”

He also subscribed to Hippocrates’s humors theory which stated that mood is determined by imbalances in one of the four bodily fluids: blood, yellow bile, black bile and phlegm. Clearly a pioneer of the BPS model.

Looking forward to @dave30th ‘s further analysis. Thanks for another important blog.
 
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