A guide to commissioning of MUS services across the UK healthcare system. M.E included.

[lilpink]

Same document, - http://www.jcpmh.info/good-services/medically-unexplained-symptoms/- page 9

Under – IMPACT ON CLINICIANS – General Practitioners- the authors say that “GPs also reported that they often find it stressful to work with patients with MUS” - reference number 30 - this study -

General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study.

Dowrick C, Gask L, Hughes JG, Charles-Jones H, Hogg JA, Peters S, Salmon P, Rogers AR, Morriss RK.

BMC Fam Pract. 2008 Aug 19;9:46.


So is that what the reference study says? – well kind of. In Table 1 of the Results we see that, of the total number of participating practitioners who were presented with various statements and asked to what extent they agreed/disagreed with them, 11% completely agreed and 61 % partly agreed with the statement ‘ I find that patients with PMUS often cause me considerable stress’, so 72% in total. So far so good. But what the authors of this Guidance for Commissioners fail to say is that the study also showed that:


· 19% (completely) and 54% (partly) - so 73% in total - agreed that they find that patients with PMUS presented them with interesting diagnostic challenges


· 26% (completely) and 57% (partly) – so 83% in total - agreed that they find that patients with PMUS presented then with interesting therapeutic challenges


· 21% (completely) and 44% (partly) – so 65% in total – DISGREED with the statement ‘I think patients with PMUS take up too much of my time, which I could use more productively with other patients’ …..


………NOT exactly the impression that was conveyed to the reader by the authors of the Guidance for Commissioners who presented a wholly negative picture of GPs attitudes towards these MUS patients.

 

[lilpink]

Same document, - http://www.jcpmh.info/good-services/medically-unexplained-symptoms/- page 9 again

Under – IMPACT ON CLINICIANS – General Practitioners - the authors also claim that


“The negative emotions experienced by doctors can have a major impact on the doctor-patient relationship, resulting in their personal feelings impacting on their professional judgement.” …and cite reference 31 – this study:



Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. (2002),


Wileman, L., May, C., & ChewGraham, C.A.


Family Practice, 19(2): 178-182. 31


https://academic.oup.com/fampra/art...cally-unexplained-symptoms-and-the-problem-of



Now first I should point out that one of the two main authors of the Guidance for Commissioners document is Professor Carolyn Chew-Graham, so she has cited her own paper here.


So let’s look at the study…..does it support the claim?


Well, this qualitative study conducted semi-structured audio-taped interviews with 15 GPs from the North-West of England. The interviews were then transcribed and analysed.



In the relevant section of the Results we read under


“Frustration for the GP; harm to the patient”


that “Patients were described as ‘frustrating’ or ‘heartsink’” and that doctors showed a “spectrum of emotions from inadequacy to the resentment and fear of such patients who could dominate and manipulate the course of the consultation”


Also that…..


“A strained doctor–patient relationship was recognized as being potentially harmful to the patient, with the doctor's personal emotions compromising their clinical professionalism.“



Now we may recognize this from our own personal experiences but there is a problem with Professor Chew-Graham using this in the document because in the Conclusion of her paper we are told that the study is ‘limited in scope’ and was with a ‘relatively small group of doctors’ so is not ‘generalizable to the wider population of GPs’. She is using a non-generalizable study to make a sweeping statement that will be inferred by the reader to apply to all GPs. The whole (and wholly) negative ‘IMPACT ON CLINICIANS’ section seems designed to infer that MUS patients are the most difficult and problematic patients to deal with and it is therefore the MUS patient's own fault if doctors’ judgements are consequently impaired.


Well if generalization (from an extremely small cohort) is the order of the day then perhaps we too are entitled to generalize to the whole GP population the following quote from one of the GPs in the study:


“You can get yourself into the position where you will never spot an illness in this patient if it was staring you in the face and they were dead on the floor, because you will feel it's just their bloody somatising.”



Rather than peddling how ‘people with MUS’ (NB not even how ‘‘MUS’ symptoms’ ) impact on the doctor-patient relationship, Professor Chew-Graham should instead be highlighting how dangerous the SOMATIZING THEORY is and how it damages doctor-patient relationships and puts MUS patients in serious jeopardy.

 

[lilpink]

Do please look at this article whilst paying particular attention to the comment from 'anon'.

http://primarycarekeele.blogspot.co.uk/2017/02/mus-guidelines.html

Poor loves... people with 'MUS' (sic) make doctor's stomachs churn. Seriously this woman puts this into the public arena as a tool to persuade people of her argument. It's obscene:

"
During some of my earlier research, conducted with medical students, GPs were interviewed about their experiences of managing patients suffering from MUS. One particularly notable quite illustrated the impact that patients with MUS has on GPs;

"Some make your stomach churn when they come in...very nervous. They make it very clear they are taking charge; and they do, they take charge, and there is nothing you can do". (GP quoted in the Wileman Paper)""

 

[slysaint]

comment from 'anon'.

Deserves posting:
"
Anonymous22 March 2017 at 21:50
These MUS Commissioning Guidelines are deeply flawed and discriminate against women in particular.

The references cited directly contradict what is written in the text. The Guidance claims that a risk factor is being female, but the references cited in the Guidance show that there isn't any significant gender predominance. Just as she does above, in the Guidance Professor Chew-Graham presents a wholly negative view of both MUS patients and of doctors' attitudes towards them, and she omits to include the more positive attitudes from the research cited.

She also generalizes from her own non-generalizable study and the authors present a table of MUS rates in various outpatient specialties putting Gynaecology at the top of the table with a 66% rate when they should be aware that there was another very similar study that put gynaecology in the middle of the specialty table. It seems that the authors are intent on defaming women in relation to MUS when there is no evidence cited to support this. Oh, and I nearly forgot to mention....the Guidance includes patients with CFS/ME, even though this condition is classified as neurological by the WHO and not psychiatric.

Also, Professor Chew-Graham's statement above about the cost of MUS is wrongly worded and therefore misleading to all who read it. It implies that 10% of the total NHS expenditure is being spent on MUS patients in the working age population in England......what I believe she means to say is that 10% of the NHS funds that are spent on the working age population is actually spent on MUS.....which is clearly NOT the same thing at all.

Indeed the phrase seems to be deliberately designed to mislead anyway......where else do we read about funding/costs being expressed as a percentage of the NHS expenditure of the working-age population rather than as a percentage of total NHS expenditure? But even that 10% figure is in serious doubt when you look at the paper from whence it came. What is not mentioned is that the authors of that paper (Bermingham et al) said that the figure of approx. £3 billion could be out by a much as 30% so the figure could in fact be 30% lower. Yet Professor Chew-Graham fixes the £3 billion in concrete by using the 10% of NHS expenditure phrase.....it all smacks of gross misrepresentation to me.

One might suppose that there could be a hidden agenda here. First brainwash doctors into believing that medically unexplained symptoms are the result of a psychiatric somatising condition.....they couldn't possibly be due/related to ADRs, misdiagnosis, testing error, admin error, Hickam's dictum, or not-yet-elucidated diseases now could they?

I suspect it's far easier to get doctors and NHS commissioners to believe that MUS is the result of some neurosis rather than of a failure of current medicine if hapless women are shown to be the main culprits.....so defraud the reader by telling them that they are. Malign these female patients with a long string of negative comments about how dreadfully they impact on their saintly doctors, then dole out cheap CBT to them rather than sending them for the proper biomedical investigations and assessment that they deserve as paid-up members of society. Even label them with a special clinical code to make sure that these 'resource wasters' don't get investigated by any other doctors.

NB This NHS Government strategy directly pits funding for physical healthcare against funding for psychiatry (IAPT- cheap CBT). (see NHS Transformation Call to Bid - IAPT).

And there you have it,the Government's efficiency savings served up on a plate......outpatient and diagnostic secondary care services decimated and at the expense of women's health in particular."

this style sounds familiar(?)

 

[lilpink]

see also : http://forums.phoenixrising.me/inde...cally-explainable-symptoms-the-new-mus.50167/