NHS Bristol on 'Management of somatoform disorders' - read this and weep.

[Countrygirl]

Our Vision & Values
Our aim is to provide our patients with best practice, high quality care and treatment that is comparable to the best in the world. We want to care for our patients in a safe environment and ensure that everyone has an outstanding experience

.

 

[Countrygirl]

The standard of English doesn't improve with the next document either:

Somatoform Disorders Referral
Somatisation disorders is a disabling condition with varying severity but poorly understood condition where patient’s presents with various symptoms indicative of a medical or neurological condition.

Astonishing that the employees of North Bristol Health Trust are so poorly educated.

 

[Large Donner]

Attempt to be the patient’s only physician and to minimise patient’s contact with other healthcare professionals.

Wow how is that remotely ethical. Are people allowed prostate check ups or mammograms or cervical smear tests?

How is a statement like that not a red flag to other health professionals?

 

[Kalliope]

I have taken a copy of it for future reference though.

Just unbelievable.....

Completely off topic, and my apologies for that - but could an archive of "unbelievable stuff said about ME by professionals" be an idea to make here at PR? I often think about saving quotes and articles, make screenshots, and then never get around to it. But such an archive could get useful one day as documentation of how bad things really are.

 

[RogerBlack]

Completely off topic, and my apologies for that - but could an archive of "unbelievable stuff said about ME by professionals" be an idea to make here at PR? I often think about saving quotes and articles, make screenshots, and then never get around to it. But such an archive could get useful one day as documentation of how bad things really are.

As a general point, remember archive.org. In addition to general archiving, it can do specific point at a page archiving.

https://web.archive.org/web/*/https...ry-clinicians/management-somatoform-disorders for example, shows it was first archived in May 2016.

 

[CFS_for_19_years]

• Look out for sings rather than symptom, if necessary a brief physical examination
• Use appropriate investigations to exclude physical cause, but discuss implications of negative test beforehand, avoid tests and procedures, unless indicated
• Clarify psychological and mood factors
• ‘Dry out’ physical symptoms

• 
  What "sings" might get their attention?
  Which tests and procedures should be avoided?
  "Dry out" physical symptoms? WTF does that mean?

ETA: Found another one:

Inform your colleges of your management plan and have a contingency plan in case of crisis or emergencies.

And which college might that be? Hopefully not the same college where you never heard of the word "colleague."

 

[lilpink]

The grammatical errors are extraordinary ... has this been written by a 7 year old who failed their SATS?

In terms of 'sings', could 'Falling apart at the seams' (Marmalade) be one example?

 

[RogerBlack]

In terms of 'sings', could 'Falling apart at the seams' (Marmalade) be one example?

For those not familiar with the parlance, Signs are things you observe about the patient.
Symptoms are what they tell you.

So, 'patient reports he has no legs' vs 'patient has no legs'.

 

[Chrisb]

I think this should be interpreted as a very clever, not to say, subversive metaphor for the whole BPS canon.

It has clearly never been edited, nor been anywhere near anyone with any understanding of the subject.

 

[Forbin]

• Understand worsening and new symptoms as an emotional communication rather than a manifestation of new disease

What could possibly go worng?

 

[Valentijn]

What could possibly go worng?

Indeed. Fortunately having a psychosomatic diagnosis is the miracle vaccine against ever developing any biomedical disorder

 

[Manganus]

What "sings" might get their attention?

And which college might that be? Hopefully not the same college where you never heard of the word "colleague."

Clearly a case of (mild?) dyslexia combined with lack of funding for a good proof reader.

 

[AndyPandy]

Disgraceful

 

[trishrhymes]

Some of the advice to clinicians is encouraging abuse - the sort that in relationships is called coercive control:

''Attempt to be the patient’s only physician and to minimise patient’s contact with other healthcare professional.''

''Build up a therapeutic alliance with the patient’s nearest relative by informing them of the management plan''

''dysfunctional automatic thoughts are identified and modified, ''

''Understand worsening and new symptoms as an emotional communication rather than a manifestation of new disease''

Here's a definition of coercive control:

Coercive control is a term developed by Evan Stark to help us understand domestic abuse as more than a “fight”. It is a pattern of behaviour which seeks to take away the victim's liberty or freedom, to strip away their sense of self.

I would add to this definition - separates the victim from sources of support and help - family and other professionals.

 

[Jenny TipsforME]

As a Bristol patient this leaves me close to tears

Like a few of you I find advice to keep the patient away from other doctors disturbing. Doctors have specialisms. How can one doctor be confident that they haven't missed something?

Also this bit

• "Acknowledge the patient’s symptoms as real, be direct and honest about areas that you agree on and those that you don’t agree
• Look out for sings rather than symptom, if necessary a brief physical examination
• Use appropriate investigations to exclude physical cause, but discuss implications of negative test beforehand, avoid tests and procedures, unless indicated"

The advice to acknowledge symptoms as real is disingenuous in the extreme in this context. Doctors clearly aren't defining "real" in the same way as patients and it becomes nearly impossible to have meaningful communication. It creates a relationship of distrust and confusion.

How are you going to spot signs (?) if you don't do a physical examination? Therefore, this is normally necessary rather than optional as implied.

It is a contradiction to say "exclude physical cause" and then "avoid tests and procedures ". The point of tests is to find physical cause. If you don't do the right tests you won't find the cause. Presumably all NHS tests are only 'if indicated ' so to mention it communicates something else. I went untreated for POTS for years because of UK policy to avoid testing pwme for this. Within hours of starting heart specific beta blockers a number of symptoms substantially improved. I could have felt better than I did for years.

I think this is bad enough to expect it is removed and for there to be an investigation into why this happened and to stop anything like it happening again.

Might someone who lives in the area raise it with their MP?

I'll have a think about writing to my MP, but my instinct is to keep my neck under the parapet for this one. I do quite a lot of general advocacy but I'm not sure about the wisdom of taking on healthcare in the place where I need healthcare! Is there a non Bristol person who could query this or someone who isn't a patient? Perhaps @Jonathan Edwards ?

 

[ladycatlover]

Well I don't think they'd approve of this "sing", but it's good advice for all of us!

 

[HowToEscape?]

The standard of English doesn't improve with the next document either:



Astonishing that the employees of North Bristol Health Trust are so poorly educated.

I don't think it's a poor education I think it shows an arrogant student.
I found that people who use English in that manner not only don't care about language; they have an active dislike of good English and people who respect it. You have to spend a number of years actively rejecting your basic schoolwork & instruction in order to so mangle your language.

 

[CarolB]

As a Bristol patient this leaves me close to tears

Like a few of you I find advice to keep the patient away from other doctors disturbing. Doctors have specialisms. How can one doctor be confident that they haven't missed something?

Also this bit

• "Acknowledge the patient’s symptoms as real, be direct and honest about areas that you agree on and those that you don’t agree
• Look out for sings rather than symptom, if necessary a brief physical examination
• Use appropriate investigations to exclude physical cause, but discuss implications of negative test beforehand, avoid tests and procedures, unless indicated"

The advice to acknowledge symptoms as real is disingenuous in the extreme in this context. Doctors clearly aren't defining "real" in the same way as patients and it becomes nearly impossible to have meaningful communication. It creates a relationship of distrust and confusion.

How are you going to spot signs (?) if you don't do a physical examination? Therefore, this is normally necessary rather than optional as implied.

It is a contradiction to say "exclude physical cause" and then "avoid tests and procedures ". The point of tests is to find physical cause. If you don't do the right tests you won't find the cause. Presumably all NHS tests are only 'if indicated ' so to mention it communicates something else. I went untreated for POTS for years because of UK policy to avoid testing pwme for this. Within hours of starting heart specific beta blockers a number of symptoms substantially improved. I could have felt better than I did for years.





I'll have a think about writing to my MP, but my instinct is to keep my neck under the parapet for this one. I do quite a lot of general advocacy but I'm not sure about the wisdom of taking on healthcare in the place where I need healthcare! Is there a non Bristol person who could query this or someone who isn't a patient? Perhaps @Jonathan Edwards ?

I understand that this has been brought to the attention of the Countess of Mar. I agree with all the comments here. It's absolutely appalling.

 

[anniekim]

30,000 per year increase in deaths in disabled in the UK under DWP/ATOS style policies, using published government data, and the debate was mainly about whether or not the tests were fair. I considered it genocide when it continued. Why weren't there mass protests from the whole populace?

@alex3619, The 30,000 figure (30,000 excess deaths in 2015 in UK population) is suspected to be in relation to social care cuts and NHS underfunding, not DWP benefits. Though DWP new disability assessments are dreadful of course, as are social care cuts and inadequate NHS funding.

"Researchers exploring why there has been a substantial increase in mortality in England and Wales in 2015 conclude that failures in the health and social care system linked to disinvestment are likely to be the main cause.

There were 30,000 excess deaths in 2015, representing the largest increase in deaths in the post-war period. The excess deaths, which included a large spike in January that year, were largely in the older population who are most dependent on health and social care."

http://www.taxresearch.org.uk/Blog/...excess-deaths-in-the-nhs-caused-by-austerity/

 

[alex3619]

The shocking 30,000 figure is in relation to social care cuts and NHS underfunding, not DWP benefits.

This is even earlier findings that have largely gone unreported, and were obtained due to an FOI. It is correct to say that the cause of these deaths was not recorded, but it was after the big change in policy. So this might indeed have been a care underfunding issue. However the figure I cited was for DISABLED people only. The other 30,000 figure appears to be somewhat separate, and possibly includes aged care and definitely includes sick people. The figures I am basing this off, and I calculated years ago, relate I think to 2012 and 2013. What the 2015 figure might show is that the problem continued unabated, though its more likely this is a sign of additional failures. As a probable result of this data going public the bureaucratic rules changed and this data is no longer even collected.

If the increase in deaths was consistent over the course of this period then there might have been as many as 120,000 extra deaths by now. That is one way to balance the budget.

Just to be clear, this was from the data showing the death rate for disabled people doubled.