Source: ACNR • VOLUME 4 NUMBER 6 • JANUARY/FEBRUARY 2005
“What should we call these symptoms?
There is a baffling array of terms, to list a few:
1. ‘nonorganic’,
2. ‘psychogenic’,
3. ‘hysterical’,
4. ’somatisation’,
5. ‘conversion disorder’ and (the title we were given for this review)
6, ‘unexplained neurological symptoms’.
We prefer the old term ‘functional’ symptoms because:
(a) it doesn’t offend the patient by implying their symptoms are ‘all in the mind’;
(b) it sidesteps unhelpful and illogical dualistic debates about whether symptoms are in the mind or the brain;
(c) functional imaging studies are beginning to discover the neural correlates for some symptoms;
(d) neurologists can diagnose them reliably and on positive criteria; and
(e) it provides a useful explanation to the patient for why things have gone wrong (‘Your nervous system is not damaged but it is not functioning properly’)”
“the misdiagnosis rate at follow up for patients with functional neurological symptoms in modern case series is consistently under 10% and usually around 5%. This is the same rate as for other neurological and psychiatric conditions such as MS and schizophrenia. When neurologists do get it wrong, gait and movement disorders and patients with a psychiatric history (probably because this biased the diagnosis) figure disproportionately.”
1. Indicate you believe the patient: “I do not think you are making up or imagining your symptoms”
11. Making the psychiatric referral: ‘I don’t think you’re mad but Dr X has a lot of experience and interest in helping people to manage and overcome their symptoms’”
Before I give KAZOOM a chance to respond just a few minor details.
"It doesn’t offend the patient by implying their symptoms are ‘all in the mind’, that just makes me laugh. Lying to patients who know damn well they have a physical problem and then saying it is all in your mind, you have false illness beliefs and more quackery terms. And we should be happy ......
Yes of course people go to a neurologist when they have a problem and they are worried that they have a braintumour or so. But they are very happy once the scan comes back normal, or do they suffer from Functional Bullshit Syndrome as well guys ????
A few years ago there was a survey from a MS organisation. On average it took 1-3 years before patients were diagnosed with MS in this day of we know it all technology.
In those 1-3 years these patients suffered from:
1. silly docs
2. and diagnosis like Functional Symptoms untill someone got their act together.
3. and they were right, they did have a major problem ... called MS and not Functional Bullshit Syndrome ....
Furthermore, in 2005 a scientist called Hugo Vrienken demonstrated that brain tissue from MS patients that looks normal on a MRI scan is already diseased if you use quantative MRI scanning and if you compared scans from MS patients that were deemed abnormal with normal MRI scanning, than with his technique one could demonstrate that the disease had progressed a lot further and that so called healthy brain tissue on a normal MRI scan was already diseased.
So wakey wakey guys from the functional brigade.
But I know, it is a lot nicer to use the old terms like hysteria etc for MS….
Furthermore, if we misdiagnose 5% that is one in twenty guys. So if I assume that these figures are correct, and I don’t but that is another issue, as these docs just never fail to amaze me with their we know it all attitude, than lets talk motor racing.
If every one in twenty refuelling pit stops goes wrong, as that is what we talk about, then we would have a DRIVER burning at every GP as we have twenty cars in a race.
If all of them stop twice then we have two cars burning with drivers, mechanics etc involved. I know we’ve had problems with the refuelling rigs but one in twenty is way too much guys.
A bit like a surgeon cutting off the wrong leg or breast in every 20th patient he operates on. Not good news I would think, but normal practice in neurology…
And the result is that for years you are treated as a malingering sod yet the docs were blatantly wrong.
Will they apologise, well I don’t think so either………..
And then there is:” functional imaging studies are beginning to discover the neural correlates for some symptoms” so more and more we start to find out that these patients actually do have a physical problem but we as docs are too daft too ….
Just remember Celiac disease for which we have a bloodtest, yet it still takes an average of FIVE years to diagnose the disease.
90% of patients have bloodtests and one in THREE sees a consultant and has an endoscopy. All were negative so they had a functional problem for FIVE years (on average, so it could be SIX, SEVEN or more years of seeing a psychiatrist talking at you instead helping the cells in your GUT !!!).
They all have to see a psychiatrist until a smart doc decides to do the right blood test.
Suddenly these malingering sods, become patients who have been right all the time that they have a physical problem. We solve it with a gluten free diet, and not psycho therapy. I know, just a minor detail…..
Anyway, I will leave the commentating to KAZOOM.
And what does KAZOOM have to say about this: Well 2 things actually:
First of all he talks about:
Appointment - Functional Neurological Symptoms
And then:
I knew It was Coming But I am So Mad !!
Now A.J. Allmendinger; who was driving a Champcar, and not an F1 car, that runs on Methanol with fuel hoses etc that never leak, has kindly offered his help to show what happens if the figures of these docs are right and we would have a burning patient and his family etc until the docs sort their business out.
Inside the patient something like this is happening but I agree, it is all part of our imagination, malingering, hysteria and false illness beliefs but we don’t want to offend the patient so we would call this Functional Neurological Symptoms. And that is what is happening here to Allmendinger and his team, just watch and you will see a Functional Invisible Methanol fire, yet it is out there ….
Oh, and if you want to read the whole article, than you can download that here ……….
I love Kazzoom's videos. :)
ReplyDeletePrior depression etc shouldn't be an excuse for the rate of misdiagnosis. Sometimes I wonder what planet these people are from - if patients have disabling symptoms without any cause known to themselves OF COURSE they will feel depressed if they are brushed off by doctors.
Doctors and specialists don't often face repercussions for misdiagnoses, but my neighbour was told she had depression and anxiety when she went to the doctors complaining of headaches and erratic behaviour. She had a tumour in her frontal lobe. After nearly dying from 'depression and anxiety' (the ultimate fob off excuse), she has never quite been the same. Last time I saw her, she was incoherent and aggressive.
I suspect that the rate of misdiagnosis of MS is higher than 5-10%. That sounds like a rather conservative estimate, given how long patients wait and how many other diagnoses are given, many psychiatric, before they get to the bottom of it. I knew a woman who had MS diagnosed without even knowing she had it via a routine eye exam, and another who suffered from bewildering complaints for five years and was characterised as an attention-seeking malingerer for going down many routes trying to find the cause of her symptoms.
It is, quite frankly, disgraceful that 'functional' symptoms, which cannot even be proven and are only accepted as being without neurological proof even when a patient has neurological signs, are not only invoked in this way as a substitute for saying 'we don't know,' but that such a diagnosis also interferes with the doctor-patient relationship and can block further testing which may be incredibly important for these patients because new symptoms are slotted into the framework of their conversion disorder.
It's also no surprise that Mike Sharpe had a say in the article, but then again nothing surprises me much if you're in bed with UNUM.
It certainly is disgraceful, and that is putting it mildly ....
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