BMJ article: How should we manage adults with persistent unexplained physical symptoms? - looks bad.

[JamBob]

Rare and difficult diseases, as well as any that are yet to be identified or for which tests still do not exist, can take decades to be identified.

Its why I find the assertion that evidence shows that rediagnosis for psychosomatic disorders only occurs at a 4% rate is laughable. This refers to research done at a hospital where they don't do further tests on these patients, and only has a follow-up period of a year. What nonsense. Its deeply implicit that testing is adequate, and doctors are competent to diagnose these problems, whereas neither is an accurate assumption. I have to ask the question as to what the rediagnosis rate would be if adequate testing were done and doctors were following up on the patient for the 20+ years it might take.

Not to mention the fact that often - the patient never returns to see the doctor who made the misdiagnosis in the first place. Each time some dismissive, patronising, sexist doctor has misdiagnosed my (what turned out to be autoimmune disease) symptoms as "functional/psychosomatic/the result of being an emotional woman" - I have refused to go back to that doctor for any further consultations so they don't ever find out that they were wrong in the first place and don't necessarily have any feedback on their diagnostic incompetence.

That's why I always find the whole "40-50% of clinic appointments are for MUS" that gets bandied about by GPs and specialists on twitter and other social media so laughable - the statistics aren't based on any reality - they are just designed to make doctors feel good about their rubbish diagnostic skills. Not to mention I believe that the statistic is derived from one of Sir Wes's jokes of a "study".

 

[Large Donner]

Each time some dismissive, patronising, sexist doctor has misdiagnosed my (what turned out to be autoimmune disease) symptoms as "functional/psychosomatic/the result of being an emotional woman" - I have refused to go back to that doctor for any further consultations so they don't ever find out that they were wrong in the first place and don't necessarily have any feedback on their diagnostic incompetence.

Now imagine for example that you had been to four doctors like this, that's four people recorded as having MUS, not even one.

Medically Uninformed Scientism.

 

[RogerBlack]

Can anyone find good studies on 'Oh - it wasn't medically unexplained actually' figures?
I found a fascinating paper (that I cannot now re-find) about I think hong-kong physicians and their knowledge about atypical MS symptoms. (it was not good).

Ideally, these would be studies on rates of long diagnosis lags with real symptoms with a biological cause that is acknowledged to be a 'real' disease.

 

[RogerBlack]

Oh joy.
http://www.bmj.com/content/356/bmj.j268
A podcast on the above.
http://forums.phoenixrising.me/inde...rsistent-unexplained-physical-symptoms.49351/

I thought it possibly useful to split the podcast into a different thread as the content is rather different.

 

[Keith Geraghty]

ive a thousand thoughts to add - first and foremost this idea of a set of patients with persistent physical unexplained symptoms might to true to a degree, you get some very regular attendees who complain of everything but then day in day out the majority of patients have unexplained symptoms
eg - dr I have a headache "ok well if it gets worse come back or if you have any new symptoms" *unexplained
eg dr I have a backache "ok ------" unexplained

the ones who get explained are rare - maybe infections, MRI scans, blood test anaemia and so on

now for the chap who has a backache that wont go away -- I doubt very much that middle aged women have the highest rate of unexplained back ache - try find a clear reason for that, rare as rare can be

so what do to for GP - send them off to CBT - at least its something

problem comes in when you have GPs who view PPUS's as psychological and miss clear cases of cancer, heart problems and so on - and believe me this happens, thats why authors state look again

then you have ME/CFS - clearly biological basis, but medics cant explain as such so its off to CBT too

Wooly makes a great point that somatic is used as psychological when the term means of the body - its been adopted into psychiatry as mind body mix

tracing the literature back its the Salmon Stanley Peters paper on an "affirmative diagnosis and telling them patient they have MUS or PPUS (what ever you call it) seems to be the trend, lets not look too hard lets just say its unexplained and send for psychotherapy - its lazy medicine and lazy science and the more you synthesize these studies all you come up with is nothing (called heterogeneity)

 

[Ambrosia_angel]

Most people with medically unexplained symptoms have tests that come back positive after some time. My new Dr has told me that my symptoms now are all related to a new condition but I know that I've had this same illness all along. It's just showing on tests now.