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KCL education module on medically unexplained symptoms

Dolphin

Senior Member
Messages
17,567
[Chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome are the most common conditions mentioned when "medically unexplained symptoms" (or syndromes) are mentioned in general]

http://keats.kcl.ac.uk/course/view.php?id=28600

A warm welcome to the IMPARTS study module ‘Mental Health Skills for Non-Mental Health Professionals’. We are delighted that you are joining us on this innovative course designed to improve the mental health skills and confidence of clinicians working in the general hospital setting.

I haven't actually looked at this in detail myself but imagine I would get annoyed by it.

Session Description:

This session provides a framework for recognition, assessment and management of medically unexplained symptoms in general hospital settings and a framework for management of people who frequently attend hospital.

Learning Objectives:

By the end of this session you should be able to:

  • Give a working definition of medically unexplained symptoms
  • Outline the impact of medically unexplained symptoms on individuals and services.
  • Describe common presentations of medically unexplained symptoms, recognising their variability
  • Describe the conditions which are commonly associated with medically unexplained symptoms in general hospital patients e.g. depression
  • Outline the core steps involved in assessment of MUS
  • Describe approaches and strategies for management of patients with MUS
  • Outline ethical dilemmas/difficulties in assessment/management of MUS
  • Describe the approach to managing patients who frequently attend hospital.
Session Introduction:

Patients with medically unexplained symptoms represent a significant proportion of people presenting to medical services both in primary and secondary care. Medically unexplained symptoms are encountered in all medical specialties for example non cardiac chest pain in cardiology, fibromyalgia in rheumatology and non-epileptic seizure disorders in neurology.

Medically unexplained symptoms present a diagnostic challenge to medical services and there is a risk of over investigation and iatrogenic harm as a result of unnecessary investigations and procedures. Clinical teams may feel challenged by patients who attend hospital very frequently especially if they do not have diagnosable organic pathology.

MUS may be comorbid with psychiatric disorder including depression and anxiety and this is of often missed or undertreated. Taking a clear and detailed symptom history is very important as is gathering as much information as possible from medical records.

Approaches to management include reassurance, explanation and judicious use of investigations. Treatment of comorbid depression and anxiety is important and specific therapies such as cognitive behavioural therapy can be effective in reducing symptoms distress and improving function.

Key Points:

  • Impact and importance of MUS in the general hospital setting
  • Recognition of MUS – key/common symptoms/presentations
  • Assessment of the patient with MUS
  • Management of the patient with MUS
  • Approach to management of frequent attenders to hospital
We will be discussing the following paper in the journal club session. Please could you read the paper in advance:

 
Last edited:
Messages
13,774
Looks like good reason to be deeply concerned about the quality of education students are getting from KCL. I wonder if that plays a role in KCL fighting against the release of PACE data? If they've been shown to be indoctrinating medical students in quackery, I wonder what implications this may have for them.
 

Dolphin

Senior Member
Messages
17,567
Looks like good reason to be deeply concerned about the quality of education students are getting from KCL. I wonder if that plays a role in KCL fighting against the release of PACE data? If they've been shown to be indoctrinating medical students in quackery, I wonder what implications this may have for them.
It's from this:
Welcome to King's primary web-based online learning environment, KEATS (King's E-learning and Teaching Service).

https://login-keats.kcl.ac.uk/
so possibly not just for KCL-based students.
 
Messages
13,774
So could have wider implications, and affect something that they're planning to make money from?
 

Cheshire

Senior Member
Messages
1,129
A few slides from the PWP

Still promoting Oxford criteria for CFS, that's just amazing, nobody outside the UK uses that...
upload_2016-1-4_22-22-8.png


Couldn't resist this one, their liking of improbable acronyms is just beyond reasonable
upload_2016-1-4_22-25-8.png


Wonderful activity programm.
upload_2016-1-4_22-26-31.png
 

Jonathan Edwards

"Gibberish"
Messages
5,256
This really does look bad. I would have expected my nurse specialists to come up with something a bit more professional on the PowerPoint.

How do you teach how to improve skills if you do not yet know what being skilled is because you have no evidence of benefit?
 

Denise

Senior Member
Messages
1,095
A few slides from the PWP

Still promoting Oxford criteria for CFS, that's just amazing, nobody outside the UK uses that...
View attachment 14194

Couldn't resist this one, their liking of improbable acronyms is just beyond reasonable
View attachment 14195

Wonderful activity programm.
View attachment 14196



Thanks for posting these.
I can't use the like button for your post, because I really don't like these.... but I appreciate your posting them.
 

Denise

Senior Member
Messages
1,095
[Chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome are the most common conditions mentioned when "medically unexplained symptoms" (or syndromes) are mentioned in general]

http://keats.kcl.ac.uk/course/view.php?id=28600



I haven't actually looked at this in detail myself but imagine I would get annoyed by it.

I too suspect I'd get annoyed by this.
Thanks though for alerting us to it.
 

Denise

Senior Member
Messages
1,095
;)
The three spinning cogs are interesting. I note how a pathology cog is missing. The message is that physical symptoms can only arise as result of behaviour. Other possibilities are excluded.

Probably because this module is about mental health, not diseases that have a pathology to them.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
The three spinning cogs are interesting. I note how a pathology cog is missing. The message is that physical symptoms can only arise as result of behaviour. Other possibilities are excluded.

It's an intriguing variant on the vacuous diagrams we have in immunobabble slides. At least in immunobabble slides the arrows tell you which way things are going. This one has the added advantage that it does not even tell you that - so it cannot possibly be wrong. Very clever.
 

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
This is the core of what the BPS lot do, isn't it — talk about the best therapeutic responses to something whose existence they have only conjectured. It's an incredibly effective strategy. People who don't know any better assume that the theorised condition must exist or those clever people from august institutions wouldn't be discussing it in this way.

I'm not sure which depresses me more: that they're doing it or that so many people swallow it.
 

A.B.

Senior Member
Messages
3,780
This is the core of what the BPS lot do, isn't it — talk about the best therapeutic responses to something whose existence they have only conjectured. It's an incredibly effective strategy. People who don't know any better assume that the theorised condition must exist or those clever people from august institutions wouldn't be discussing it in this way.

I'm not sure which depresses me more: that they're doing it or that so many people swallow it.

Just acting as if they had answers, knowledge, and results is apparently all that's necessary to make a career in this area. Null result? Doesn't matter, juggle outcomes and definitions until there's at least a tiny effect at some point, and then go on citing that study as evidence for your ideas. Eventually there's a sizable stack of studies that agree on several points and look impressive to the average person.

Peer review should ideally prevent this sort of thing but that is dysfunctional as well. Harder to explain how and why. Maybe the only peer reviewers with the "right skills" are people also peddling dubious bullshit in a similar manner and therefore unable to draw attention to certain problems?
 

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
Peer review should ideally prevent this sort of thing but that is dysfunctional as well. Harder to explain how and why. Maybe the only peer reviewers with the "right skills" are people also peddling dubious bullshit in a similar manner and therefore unable to draw attention to certain problems?

It occurs to me, AB, that we were being quite prescient the other day with "Mime Therapy for MUS" and "coming to an NHS Trust near you" ... http://forums.phoenixrising.me/inde...lained-symptoms-in-england.41961/#post-678524

I don't know. Is this what Nye Bevan had in mind?
 

Sean

Senior Member
Messages
7,378
This is the core of what the BPS lot do, isn't it — talk about the best therapeutic responses to something whose existence they have only conjectured. It's an incredibly effective strategy.
Sure is. In terms of the number of lives they are affecting with this shite, they are among the most powerful people who have ever lived, and they have done it all with rhetorical sleights-of-hand.

Senior politicians and public relations consultants the world over would willingly give their first born in order to possess that level of persuasion, and immunity from being held to proper account for its consequences.

I hope some budding medical historians are paying attention to this saga, coz there is rich pickings, more than enough upon which to build a few solid careers.
 

CFS_for_19_years

Hoarder of biscuits
Messages
2,396
Location
USA
I clicked on one of the modules regarding "Goal Setting" and it showed a staged interview - a doctor "helping" a patient with his sleep problems, and get this, the patient works at a pub in the evening and drinks alcohol regularly. The title under the video is
CFS: How not to get into arguments with the patient

Good to know that good patient management is equated with "not getting into arguments" and recommendations to cut back on drinking.