(I am not really here, but I want to add the following and it also relates to Countrygirl's post above.)
As previously posted, the Vincent Deary section of the PowerPoint presentation:
http://www.nescn.nhs.uk/wp-content/uploads/2015/09/20150922-Presentation.pdf
states in
Slide #31
"Our work is focusing on three PPS: Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome (IBS) and Fibromyalgia.
"These three PPS account for at least 15% of GP consultations and up to 30-50% of referrals to specialists"
GP referral rates vary from practice to practice and across the country (some parts of the country have higher rates for some diseases, for example, COPD. Some NHS Trusts have centralized triaging for screening GP referrals and not all requests for referrals will be forwarded on. Some areas of the country have higher percentage populations of over 60s, with higher referral rates to some specialties for age related diseases etc).
However that last statement:
"These three PPS account for at least 15% of GP consultations and up to 30-50% of referrals to specialists"
requires a source and Vincent Deary provides none.
I have a number of papers on file on SDs, MUS, SSD, FSSs and revisions of terminology which give figures for percentages of GP referrals to several specialities that after investigation are reported as "MUS".
However, I have no breakdown for GP referral rates for referrals to specialists specifically for CFS, IBS and FM.
I have a slide presentation on GP referral processes which gives data for referrals by percentage across a number of specialities for Ireland. It includes a figure for Paediatrics which I have removed and have adjusted the figures accordingly, which gives:
Proportion of all referrals [by speciality]
Internal medicine 32.07%
Dermatology 4.32%
General surgery 16.4%
Ophthalmology 6.3%
Obs & Gynae 17.2%
Psychiatry 3.4%
I cannot see how Deary arrives at a figure of up to 30-60% of
referrals to specialists being for CFS, IBS and FM.
What he may be quoting is estimates for what percentage of GP referrals across several specialities turn out on investigation to be "medically unexplained" which are given, variously, as between 30-66%, according to speciality.
For example,
ABC of Medically Unexplained Symptoms edited by Christopher Burton gives the following:
Prevalence of medically unexplained symptoms in new referrals to different specialities:
Cardiology 53%
Gastroenterology 58%
Gynaecology 66%
Neurology 62%
Respiratory 41%
Rheumatology 45%
An article here:
http://www.bmj.com/content/322/7289/767.full.print
"Hamilton et al reported rates of medically unexplained symptoms of 53%, 42%, and 32% in gastroenterology, neurology, and cardiology respectively9; and this finding was confirmed by Nimnuan et al, who looked at seven specialist clinics in one hospital in which 51% of new patients were diagnosed as having medically unexplained symptoms.10"
Figures vary from paper to paper, but let's say between 35-60%.
If that is the case, he should make that clear.
And if that is what he
does mean, then what he is doing is using the three terms CFS, IBS and FM (all of which have operationalised criteria) to encompass the
entire spectrum of "medically unexplained" or "PPS" symptom presentation.
He could have said - depending on the speciality, 30 to 50% of GP referrals are recorded as MUS or PPS, but that is not what he has said in this presentation.
So I am going to email Vincent Deary and request that he provides references for the claim he has made in this slide.
Countrygirl writes:
I also note that it is being suggested that the 'historic' idea that clusters of symptoms were listed as a syndrome such as CFS should possibly now be abandoned...So it sounds as if they are aiming to bury ME and CFS entirely........or at least raising the possibility for consideration.
Yes, that is what the Fink BDS construct seeks to do; what the Goldberg ICD-11 PHC primary care group seeks to do, with its proposed "BSS"; what the umbrella term "FSS" does, what Prof Helen Payne is doing and what the PPS services are doing - which brings us right back to the "lumping or "splitting" discourses of 1999.
It's what Creed wants, it's what Sharpe wants; it's what White wanted -
"In the future the clinics may extend to treat patients with fibromyalgia and fatigue secondary to physical illness (eg cancer)" and chest pain.
"Splitting or lumping? We are in danger of having separate clinics for chonic fatigue syndrome, chest pains, fibromyalgia etc etc...we need to join up these different clinics and get them more centrally placed on the agenda - make them more visible to all specialists." [1]
And what Moss-Morris wants, lead adviser to NHS on MUS for IAPT.
[1] Report from Working group meeting on MUS/somatisation/bodily distress, Budapest July 1st 2011
https://dxrevisionwatch.files.wordp...ically_unexplained_symptoms_budapest_2011.pdf
