1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
Nitric oxide and its possible implication in ME/CFS (Part 1 of 2)
Andrew Gladman explores the current and historic hypotheses relating to nitric oxide problems in ME/CFS. Part 1 of a 2-part series puts nitric oxide under the microscope and explores what it is, what it does and why it is so frequently discussed in the world of ME/CFS. Part 1 focuses...
Discuss the article on the Forums.

"Managing Medically Unexplained Symptoms" (advice to GPs/PCPs)

Discussion in 'Action Alerts and Advocacy' started by Dolphin, Apr 13, 2010.

  1. Dolphin

    Dolphin Senior Member

    Messages:
    6,525
    Likes:
    4,929
    Somebody posted this on another forum. I understand it is on a UK website for doctors.

    Warning, you may find it infuriating! :(

  2. Mark

    Mark Acting CEO

    Messages:
    4,503
    Likes:
    1,925
    Sofa, UK
    Perhaps Adam should get to work on this piece of foul excrement! Although it should be handled with care: it is clearly designed to induce dangerous levels of enragement. But I couldn't bring myself to ask anyone else to wade through this, so here's my abridged and de-Newspeaked version.

    "Mental Advice for Criminal Neglect: Top Tips for Non-Experts"

    Part 94: What You Don't Know Can't Hurt You

    Patients you can't figure out can be a right pain in the arse, especially when you keep telling them there's nothing wrong with them and they won't believe you. Somatisation disorder, hypochondriacal disorder, and dissociative (conversion) disorder are a suite of labels you can use to chuck any such person over to Mental Health for further processing.

    There is little evidence. There is no proven treatment. (To be strictly accurate, there logically can't be any evidence, but don't worry, this can actually be quite useful).

    Try my Extended Reattribution and Management Model (ermm): whatever they say, let them waffle on, then simply reply "You say that x...", and when the time's up, make another appointment.


    ERMMs and OARS

    OARS: How to convince a patient that you are understanding and sympathetic.
    (Note: It is very important that they believe this).

    1. Open Questions: Encourage them to waffle on about whatever they like (but not too much obviously, they will probably want to whinge) and don't ask detailed questions.

    2. Affirmations: Imply you are listening sympathetically by saying things like "Oooh that must be horrible".

    3. Reflective listening: Free Time/Verbal Ping-Pong.

    4. Summarising: Repeat back what they have described using wording that subtly suggests it might not be real.



    Further things you can try:

    * Chat about depression and anxiety;

    * Muse about the mind/body problem;

    * Explain that we don't know everything and then confidently tell them there's definitely nothing seriously wrong with them;

    * Latch on to them and make sure you become their doctor, then warn all the local doctors that the patient is only imagining they are ill;

    * Book regular appointments as a cunning way to actually see less of them (obviously desirable);

    * And - as always - if all else fails, stick 'em on Prozac.



    REFERENCES
    ----------------

    Dishonesty \Dis*hon"es*ty\, n. [Cf. OF. deshonest['e], F. d['e]shonn[^e]tet['e].]

    1.Dishonor; dishonorableness; shame. [Obs.]
    ``The hidden things of dishonesty.'' --2 Cor. iv.
    2.[1913 Webster]

    2.Want of honesty, probity, or integrity in principle; want of fairness and straightforwardness; a disposition to defraud, deceive, or betray; faithlessness.
    [1913 Webster]

    3.Violation of trust or of justice; fraud; any deviation from probity; a dishonest act.
    [1913 Webster]




    Unlike Dr Sarah Myhill (currently under investigation for offering such people effective, evidence-based advice and treatments) may I presume his licence is not currently in question?
  3. Kati

    Kati Patient in training

    Messages:
    1,835
    Likes:
    907
    Well done Mark !!! :rolleyes:;):victory:;):victory:;):victory::rolleyes:
  4. Mark

    Mark Acting CEO

    Messages:
    4,503
    Likes:
    1,925
    Sofa, UK
    :D;)

    :sofa:
  5. xrayspex

    xrayspex Senior Member

    Messages:
    659
    Likes:
    70
    u.s.a.
    lmao thanks mark

    ugh, I work parttime as a social worker and those OARS which is part of motivational interviewing (MI) is all the rage right now in certain parts of the states. the techniques can be useful to help facilitate conversation and William Miller is a big researcher and trainer of it in NM, Carl Rogers was the grandfather, forefather of some of these ideas but I don't think he intended them to be misused like this. I have had mixed feelings about it as a trainer I know is so passionate about it he wants all counselors trained in it rigorously and their sessions taped and then coded, yes they have a way of coding it to make sure the therapist or doctor or whoever is saying it exactly right in their reflection back to client, there is a "science" to it and its considered evidenced based (EB) supposedly, lots of research behind it. I havent heard of them using it in midwest to try to get out of treating cfs or fm patients but they are teaching it to clinicians in university hospitals and I have wondered how long until it does become sort of 1984ish way to manage costs. Where I see it used more is with people who need counseling for alcohol and drug problems to not make them defensive. But my concern is that it seems to me that it could be used to try to manipulate people to the therapists goals and not their own but make it seem like the client came up with the idea on their own. Its very irritating to me when I can tell my coworkers are doing it to me or other peers, feels condescending. We have had arguments about it at work and the funny thing is the top guy trainer proponent of it was trying to use it on me to talk me into how great it was and after a couple hours of that and he wasnt making headway he threw a tantrum and threatened me haha it was such poetic justice to watch......
  6. Dolphin

    Dolphin Senior Member

    Messages:
    6,525
    Likes:
    4,929
    Thanks Mark.

    Love it!
  7. Mark

    Mark Acting CEO

    Messages:
    4,503
    Likes:
    1,925
    Sofa, UK
    Hi xrayspex, I liked your post, it provoked some very interesting thoughts which I then lost in posting my reply. :(. Try again...

    No, it's gone. :( Damn, it was really good stuff too :D

    Anyway: I loved your account of the therapist blowing up when you stood your ground: says it all for me. I totally agree that I find the approach condescending and irritating - I'll add patronising, insulting, dishonest. I have to say I'm coming round to the view that all these dishonest distortions of psychology are the root of so many problems in the world. It seems to me that any form of psychology that doesn't manage to be completely neutral in the model it projects on the individual, runs the risk of distorting that patient's reality with its own pet theory. In this case, if you go in with the idea that somebody is not really sick - of which you have no proof - and that they are somatising - of which there can be no proof that this happens - then these are the results you create. Even the very idea that this stuff exists means that I go in to see a doctor being completely unable to trust him/her, and that's the most insidious thing of all IMO. Our whole story may all be as simple as that: the errors of psychology and psychiatry. I think it's all probably an honest human error, in signing up to a seductive but wrong idea, but it's a catastrophic one. The latest moves on the horizon though, to expand all this movement, are really frightening and we must resist them. i wonder if our best strategy is to simply turn away from the system and not feed the beast, rather than taking it on directly. But I suspect we have to do both. This illness gave us a really good insight into how the world works though, I find myself taking some comfort in all that I've learned from this experience, even though that's small consolation really, but perhaps that depends on how we use that knowledge.

    Welcome to the forums, see you around!

    Mark



See more popular forum discussions.

Share This Page