Month: April 2019
The Cult of MUS
This post (in response to a new paper promoting the use of CBT for IBS) is by my colleague Couch Turnip and originally appeared as a comment here: http://www.virology.ws/2019/04/15/trial-by-error-crowdfunding-week-2-and-more-sharpe-and-chalder/ (with some changes by the author)
For those who are new to this issue and may be unfamiliar with some of the acronyms,
MUS – Medically Unexplained Symptoms
BPS – Biopsychosocial
IAPT – Improving Access to Psychological Therapies
This MUS cult is so dangerous. It’s flavour of the decade because, apart from being a whacky belief system, it is also an economic management model that has been built on the management model for ME/CFS. The BPS cabal have succeeded in depriving ME/CFS patients of care, proper investigation, research and the chance of effective treatment for far too long, and now they’re extending the same model to everyone else, and especially to those who have unexplained symptoms. (That’s just about everyone who goes to a GP before they get diagnosed.) What better way is there for governments, health services and insurance companies to save money than to tell people that their symptoms are due to psychological problems and deny them biomedical care on that basis from the outset?
The risks should be obvious (well you’d think). The differential diagnosis for IBS includes – inflammatory bowel disease (IBD), endometriosis, GI tract cancer, ischaemic colitis, giardiasis and coeliac disease. On the basis of a rushed 8 minute consult GPs are to send their patients off for telephone CBT / IAPT instead of referring them to secondary care. The UK already has a poor track record of diagnosing cancers at an early stage, with patients often having to go back to their GPs many times before the correct action is taken, so an additional delay for CBT could well be catastrophic. And IBD is often misdiagnosed as IBS. Speaking from recent experience, if gastroenterology consultants are incapable of diagnosing IBD from a patient’s history then what are the chances that GPs will get it right? This is shoddy science leading to dangerous medicine, and unfortunately this model is taking off across the globe.
What started out looking like a cruel vendetta against ME/CFS sufferers has morphed into an economic strategy with global reach. But this has been in the planning for a long time. It is not an underestimate to say that millions are now at risk.
Here’s another post written not by me but by Couch Turnip, who originally left it as a comment on the previous post ‘The Cult of MUS‘ (which was also written by her!) As so often with the stuff she writes, I thought it deserved a wider audience. It seems to summarise very powerfully the shortfall in both logic and compassion which lies at the heart of MUS. I don’t know which it is hardest to comprehend: that those in authority should encourage this change in mindset or that those required to make this change should apparently be so willing to embrace it.
It’s hard to believe that the practice of medicine itself would be manipulated and used as a tool to cut costs, but that is unfortunately where we’re at now.
I had an experience last summer that will stick in my memory. The attitude of hospital staff towards someone I was accompanying seemed to change dramatically with their perception of the situation. When the (young adult) attendee was clearly unable to walk and was struggling to stand up then staff behaved in an exemplary manner towards them – they appeared caring and sympathetic, rushing to help and locating a wheelchair in a hospital where such basic equipment seemed in very short supply. But on wheeling the patient into a different department about 10 metres away, the attitude of the staff was noticeably different. Here the patient, now marginally less compromised on account of the wheelchair, was treated as if they were catastrophizing their situation and I, as the wheelchair pusher, was their facilitator or accomplice in this. When they were struggling to get out of the wheelchair for an examination/investigation, I was told to get them to hurry up and move. When I slightly raised my voice in indignation, a security prescence appeared at the door. How can 10metres and a wheelchair make so much difference?
Whatever happened to real compassionate care? What happened to believing the patient and taking their symptoms and situation at face value rather than reading all sorts of pseudo-psychology into it? What exactly are they teaching medical staff about patient management these days? I shudder to think.
Since Couch Turnip wrote the above, the case has emerged of Gigi, a young woman with ME who is being kept in a psychiatric ward against her own and her parents’ wishes. ME rather than MUS, but you might call it more of the same. You could call it ‘institutional disbelief’.
By the way, Couch Turnip didn’t leave the only comment on the previous post. There was also a very good one from gildedcage, also well worth a look.