Esther12
Senior Member
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A bit interesting as there were hints of things that I liked, along with some amazingly bad stuff. I want out!
New link: http://www.eapm.eu.com/tl_files/content/Presentations/EACLPP_Turner_MUS_2002.pdf
Old link that I'm sure was working, but is now not!:
web.archive.org/web/20040604163043/http://www.eaclpp.org/presentations/Turner%20Stokes%20MUS.ppt
A taste of it:
6:
19:
25:
26:
27:
28:
29:
31:
New link: http://www.eapm.eu.com/tl_files/content/Presentations/EACLPP_Turner_MUS_2002.pdf
Old link that I'm sure was working, but is now not!:
web.archive.org/web/20040604163043/http://www.eaclpp.org/presentations/Turner%20Stokes%20MUS.ppt
A taste of it:
6:
Establish a different attitude
‘Illness’ can be a social condition
Engenders a caring response
Admiration from peers
‘Isn’t she brave!”
Some who has found a prop
Does not necessarily want it removed
Seek medical attention
For confirmation - not cure
Diagnosis is an end in itself
19:
Iatrogenic causes
Medicalisation of pt’s symptoms
Over-investigation
Inappropriate treatment
Especially by more junior doctors
Failure to provide clear explanation for symptoms
Increasing uncertainty and anxiety
Failure to recognise and treat emotional factors
25:
Insight and Exaggeration
Insight does not mean ‘malingering’
Part of the normal human condition to exaggerate
Symptoms not life-threatening
May not perceived as important
May cause the best of us to amplify on occasion
May or may not:
have insight into this behaviour
be prepared to own up to it
Thrown a life-line:
Some will grab it
Others prefer to hang on to their symptoms
26:
Some patients
Require their ‘medical condition’
Part of own strategy for dealing with life
Come to clinic
Not for a ‘cure’
For support and bona fide status
Of ‘being under care of the doctor’
Remove the crutch
They will find another
27:
Secondary gain
Disability may hold advantages for them
Financial / Environmental
Benefits, equipment, accommodation
Support, care and attention
From family , friends / carers
Excuse for avoidance
E.g of unwanted sexual attentions
Social mystique or importance
Having a ‘rare condition’
28:
Recognise and contain
Doctors who try to achieve great change
Will be disappointed
Once identified
Patients should remain in clinic
Seen regularly, but not frequently
By the same senior doctor
Not left to junior staff
Accept symptomatology and disability
Without recourse to repeated investigations
Provide supportive interview instead (preferably with spouse present)
Approach demonstrably cost-effective (Smith et al 1986)
29:
Real difficulty
To identify those patients
Who genuinely want ‘out’
Need an honourable excuse
To surrender trappings of disability
Return to more normal function
31:
Approach to management
Identify features of organic disease
Overlaying psychological elements
Establish degree of insight
Extent to which they recognise
psychological basis for their problems
Extent to which they ‘want out’
Determine the appropriate programme
Physical / psychological / both
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