Who said: don't bother testing patients?

Peter Trewhitt said:
The references relating to GP training and to service delivery, as well as encouraging GPs to think of psychiatric diagnoses as a first not a last resort, repeatedly stress approaches designed to keep the patient on board through feeling valued and understood, but are intended to placate and mislead the patient that their symptoms are being taken seriously when in fact they are being medically ignored.

I know someone with a diagnosis of functional neurological symptoms who understands this to mean she has something similar to ME or ME itself. She has mild to moderate symptoms and does not seem to have taken on board the implication of her diagnosis that she has a psychiatric condition. [She appears to be happy that her doctor is listening to her and implicitly trust what her doctor says. The tendency of the Biopsychosocial advocates to emphasise anything that blurs the lines between the psychological and the biomedical produces a dangerously plausible pseudoscience that uninformed patients may be happy to accept.]
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It's actually the smiling, placatory, patronising bit that i find most offensive about the whole thing.

I have also come across several people saying they have FND, talking about it as if their Drs believed it was organic. As you say, the triumph of blurring.
 
…… and it is known that in patients with severe chronic fatigue a skilled interview is more likely to provide information of use to the physician than further sophisticated investigations (Manu et al 1989a; Kroenke et al1988; Valdini et al,1989).

Simon Wessely, Sue Butler, Trudie Chalder and Anthony David. The Cognitive Behavioural Management of the Post-viral Fatigue Syndrome in Post-viral Fatigue Syndrome (Myalgic Encephalomyelitis) 1991 eds Jenkins and Mowbray p316

Just as a little light entertainment, and as you have deserved it, I would offer this little digression from the Conclusion:

Does this cure PVFS? Probably not. Cognitive behavioural therapy as outlined above is intended to increase functional activity, and to decrease the profound restrictions imposed by the illness...…..Nevertheless, as in so much of medicine, our approach remains a rehabilitative, rather than a directly curative, one...…..There is little doubt that PVFS is a heterogenous condition (Swartz, 1988) so it is to be expected that our approach will not be relevant to all. Further work will be needed to ensure that the appropriate patient receives the appropriate treatment.

@p329

Where did it all go wrong?

@Jonathan Edwards I think that final passge should be brought to the attention of an expert witness.
 
I think what can also be clearly seen in this example is how similar the contents of different authors are. This is not science. I always wonder how something can be published that just cites what others have already written, without adding anything new or without something that needed extensive thinking/analysis/logic.
 
Jenny TipsforME said:
Peter White said about not doing tilt table test, though gave the reason it was too demanding for us

https://books.google.co.uk/books?id=lXcVAgAAQBAJ&pg=PA10&lpg=PA10&dq=peter+white+tilt+table&source=bl&ots=LkxNmA9l28&sig=UgrdcTszXY64qu-bcg22F4qfhJ4&hl=en&sa=X&ved=2ahUKEwixqfLGjcLeAhXRY8AKHUjcAM4Q6AEwDHoECDQQAQ#v=onepage&q=peter white tilt table&f=false

That says 2007 though I have in my mind this idea of explicitly not testing orthostatic intolerance goes back to the mid 90s.
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Nice find!

Reading on...
CharcotsBadIdea_Sharpe.png
 
" It is still not well enough known that for enduring and disabling bodily symptoms a purely biomedical explanation of the extent of the symptoms is hardly ever appropriate."

I really begin to wonder if we would be better off being treated by vets. My planned career was in plant pathology where enduring and disabling bodily symptoms were not treated with CBT
 
Peter Trewhitt said:
[added - This 'Implementing a psychotherapy service ... ...' has some interesting comments, my favourite so far is a suggestion that treating people with MUS can be so stressful for clinicians that they may end up somatising their own distress and themselves present with MUS. So not content with adding large swaths of patients to their psychiatric client list they also want to add the clinicians treating them to their patient list as well. Yet more empire building.]
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My emphasis.

This does seem to suggest that it isn't distressing for clinicians when their patients die as a result of suffering from inadequately tested and untreated "MUS".
 
The following is from Malcolm Hooper’s “Magical Medicine” http://www.margaretwilliams.me/2010/magical-medicine_hooper_feb2010.pdf

Page 4

In 1992, the Wessely School gave directions that in ME/CFS, the first duty of the doctor is to avoid legitimisation of symptoms; in 1994, ME was described as merely “a belief”; in 1996 recommendations were made that no investigations should be performed to confirm the diagnosis and in 1999 patients with ME/CFS were referred to as “the undeserving sick”.


Page 322

Sharpe maintained that: “Patients present with symptoms, but physicians diagnose diseases. In many cases, however, no disease can be found….Such complaints are commonly referred to as somatization, somatoform, or functional symptoms….they lead to a considerable, but largely wasted, expenditure of medical resources on clinical investigations”.
 
….The doctor may sense that the consultation will go more smoothly if he avoids psychological topics-with their implication that physical processes are not the only cause of the patient's predicament. So, the doctor colludes with the patient in ordering investigation after investigation, spurred on by the patient's relentless pursuit of a physical diagnosis. In colluding with one another, patient and doctor both achieve short-term gains-but the patient is left trapped by his symptoms, while the doctor is trapped on an endless merry-go-round of physical investigations, which will in the long-term confirm the patient in the sick-role.

@p911

As Sharpe has argued, (this issue), a proper assessment is an essential first step in management. Further physical investigations are avoided, but the patient is offered help for any treatable physical or psychiatric disorder which may be present.

@p917

T O Woods, D P Goldberg. Psychiatric Perspectives: an overview. British Medical Bulletin (1991) vol 47 no 4 pp908-918
 
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