5 ms·

The stuff about doctors in the UK is quite amusing. I actually look after a relative who has similar but not identical issue. Like OP, the diagnosis is madness

The stuff about doctors in the UK is quite amusing. I actually look after a relative who has similar but not identical issue. Like OP, the diagnosis is madness and advice to see a clinical psychologist (ironically, this person was a psychologist themselves). Like OP, the doctor is actually actively intervening to prevent a second opinion from a neurologist (which is slightly redundant as the conclusion will most likely be the same...although sometimes you get lucky). In what is probably not a massive coincidence, my relative probably saw the same people as OP (I live in the Edinburgh area). This unit got handed a massive stack of cash recently...BMWs all round for the boys. Recently, as my relative's condition has deteriorated, I think about this a lot (they are basically a parent to me). Doctors in the UK are, by and large, arrogant. If you want to know if someone is a doctor in the UK, talk to them...they will tell you within the first ten seconds...multiple times. Most outside primary care seem to actively dislike patients. I know multiple people who became doctors...none did anything for anyone but themselves (amazing given that almost everyone at my school was strongly encouraged to do charity work). I went to a university with a huge, well-regarded medical school...nothing that I experienced at university altered this view. There is something fundamentally, one could even say psychologically, wrong with the kind of person who becomes a doctor in the UK. But there is also something utterly wrong with the incentives: the NHS has no capacity for care outside a narrow boundary. They have "policy" in areas where this makes no sense. In this area, there is a clear medical consensus that these issues aren't psychological...outside the UK. Inside, there is "policy"...if you have any of these problems (fibro/CFS/ME) you are mad. Say what you will about the US healthcare system but in these cases, i.e. infrequent, then you actually get a decent result, doctors are paying attention to research, and they are actually willing to consider the possibility that you aren't "putting it on". The only exception is MS...unf, as it is often clear where the boundary lies between MS and some of the other things in this group, this is a largely redundant distinction to everyone but the doctors.

Engineering-MD 7y ago
It looks like you’ve had some bad experiences with doctors. I myself am a doctor in the UK, and my experience differs from yours. I would say like all humans, some of my colleagues are arrogant, and some are not. I would agree we tend to mention it early in conversation, but more because for many their whole life revolves around it (it makes discussing your life difficult if you ignore it!). The term used commonly is functional. Some people (like yourself and the article author, as well as some doctors) take this to mean they are ‘mad’. This is not the meaning of functional. It implies a lack of recognised organic pathology, with a likely cause within the brain. This is a very heterogenous category due to the lack of known biological pathology, and includes those with rare and undiscovered diseases, those with true psycho local issues causing somatisation , and those simply lying. Due to the difficulty in treating these diseases, often people attempt one of the treatments that can work for some of these people (somatisation): psychotherapy. Of course this doesn’t work for everyone, but given the low risk it poses it is worth trying. As for American healthcare, there is an incentive to overinvestigate and overdiagnose. Not all pathologies found are relevant or explain the clinical findings.
- hogFeast 7y ago
  Yes mate, it is my experience that is the problem. I would look at the research on organisational behaviour within hospitals, this is a problem with doctors everywhere and has measurable impact on people's health. And I am fairly happy with the idea that this is particularly true in the UK because my sample is not small. Your response to this is odd in itself. Why do you think I would be convinced by what you say? Why tell me you are a doctor (I can tell you: without the appeal to authority, there is no argument)? Literally, in the post you have replied to I have said...doctors in the UK tell you straight away...it took you ten words. How little self-awareness do you have? It is comical that you actually wrote that and, presumably, had some thought that it was a good idea to say any of that (again, the only reason to think that is because you think your arguments don't require justification). And great...you have wasted your life writing a paragraph explaining to yourself why you are a doctor but are choosing not to help someone who is sick. The significance of this to me, let alone some who is sick, is zero...again, lack of self-awareness...why write this at all? I am sure it is a nice thing that helps your self-image...you failed to prove its consequence in the real world (i.e. you skilfully explained what is but left out why it should be). To highlight two points again. The issue with OP and my relative is that doctors are often actively attempting to prevent further care. No-one denies that psychological therapy is helpful for chronic pain. The issue is that, for most people, it isn't going to solve anything...but it is presented as the cure even when alternatives exist. Even suggesting that people could be lying or that it is psychosomatic is wrong-headed. If that is the case, then that is another condition (lying isn't a medical condition, you don't adjust medicine conditional on the probability that someone is lying). Again, there is an obsession with people lying that is truly unhealthy here and quite contrary to practice outside the UK (indeed, my experience within the UK has been, as you have just done, that almost every doctor will start talking about the possibility of lying completely unprompted when these particularly conditions are mentioned...random?). The other issue is that this has profoundly stunted research in the UK. It is not particularly hard to find ample research on these issues. You are saying that psychological therapy is a treatment...well, read the research. Is there a known biological pathology? No. But there are possibilities (and none of those possibilities suggest the current treatment will have a significant effect...CBT, in the case of people with psychological conditions, is only effective 20-30% of the time). And is it appropriate for the "policy" to be in cases when there is no known pathology that psychological therapy (or, presumably, a lie detector test) be the only course of action? No. That isn't logical (and, again, it is why there are people who are helping people who you have actively chosen to abandon). Somewhat amazing that you go onto criticise the US system for "overdiagnosis"...so no diagnosis is better than overdiagnosis? Again...you are a doctor, right? You are just saying: I would prefer to do no work at all than hard work. Feeble, and unbelievably arrogant (it is feeble to justify doing no work, it takes arrogance to criticise others for doing work). Truly, I hope this will help you. Stop. Think it through. Think whether what you wrote helps yourself more than other people. Btw, it is often very clear in these cases (and in life, generally) when someone is or is not lying because lying usually requires motivation (I have never come across someone who was obsessed with other people "lying" for anything other than self-interested reasons). Most people who have these conditions have their lives destroyed...to suggest that someone is motivated to destroy their own life is just stupid. To suggest that this must be the case to cover up your own personal failings (competence, lack of sympathy, ending up in a job that requires sympathy when you only possess avarice, etc.) is something far worse. EDIT: just to add actual info, because we are actually talking around some of the issues here...the UK uses the Oxford criteria for ME/CFS, this is a measure that was designed by psychiatrists, and has been shown to be a statistically significant treatment in samples selected using that criteria...one issue...all these studies have massive selection bias (some of these therapies wouldn't actually be possible for people with CFS/ME to undertake, imo) and the Oxford criteria wildly overstates incidence of ME/CFS (compared to Fukuda). The Lancet, a UK medical journal, continues to publish guidance that this is a psychological condition (again, not what is said above, that there are no biological pathologies...the Lancet is saying this can be cured by psychological therapy) despite the NIH (and others) showing that this is likely not the case (and suggesting that it is actually damaging research funding to suggest it is a mental condition).

Engineering-MD 7y ago

It looks like you’ve had some bad experiences with doctors. I myself am a doctor in the UK, and my experience differs from yours. I would say like all humans, some of my colleagues are arrogant, and some are not. I would agree we tend to mention it early in conversation, but more because for many their whole life revolves around it (it makes discussing your life difficult if you ignore it!). The term used commonly is functional. Some people (like yourself and the article author, as well as some doctors) take this to mean they are ‘mad’. This is not the meaning of functional. It implies a lack of recognised organic pathology, with a likely cause within the brain. This is a very heterogenous category due to the lack of known biological pathology, and includes those with rare and undiscovered diseases, those with true psycho local issues causing somatisation , and those simply lying. Due to the difficulty in treating these diseases, often people attempt one of the treatments that can work for some of these people (somatisation): psychotherapy. Of course this doesn’t work for everyone, but given the low risk it poses it is worth trying. As for American healthcare, there is an incentive to overinvestigate and overdiagnose. Not all pathologies found are relevant or explain the clinical findings.

hogFeast 7y ago
Yes mate, it is my experience that is the problem. I would look at the research on organisational behaviour within hospitals, this is a problem with doctors everywhere and has measurable impact on people's health. And I am fairly happy with the idea that this is particularly true in the UK because my sample is not small. Your response to this is odd in itself. Why do you think I would be convinced by what you say? Why tell me you are a doctor (I can tell you: without the appeal to authority, there is no argument)? Literally, in the post you have replied to I have said...doctors in the UK tell you straight away...it took you ten words. How little self-awareness do you have? It is comical that you actually wrote that and, presumably, had some thought that it was a good idea to say any of that (again, the only reason to think that is because you think your arguments don't require justification). And great...you have wasted your life writing a paragraph explaining to yourself why you are a doctor but are choosing not to help someone who is sick. The significance of this to me, let alone some who is sick, is zero...again, lack of self-awareness...why write this at all? I am sure it is a nice thing that helps your self-image...you failed to prove its consequence in the real world (i.e. you skilfully explained what is but left out why it should be). To highlight two points again. The issue with OP and my relative is that doctors are often actively attempting to prevent further care. No-one denies that psychological therapy is helpful for chronic pain. The issue is that, for most people, it isn't going to solve anything...but it is presented as the cure even when alternatives exist. Even suggesting that people could be lying or that it is psychosomatic is wrong-headed. If that is the case, then that is another condition (lying isn't a medical condition, you don't adjust medicine conditional on the probability that someone is lying). Again, there is an obsession with people lying that is truly unhealthy here and quite contrary to practice outside the UK (indeed, my experience within the UK has been, as you have just done, that almost every doctor will start talking about the possibility of lying completely unprompted when these particularly conditions are mentioned...random?). The other issue is that this has profoundly stunted research in the UK. It is not particularly hard to find ample research on these issues. You are saying that psychological therapy is a treatment...well, read the research. Is there a known biological pathology? No. But there are possibilities (and none of those possibilities suggest the current treatment will have a significant effect...CBT, in the case of people with psychological conditions, is only effective 20-30% of the time). And is it appropriate for the "policy" to be in cases when there is no known pathology that psychological therapy (or, presumably, a lie detector test) be the only course of action? No. That isn't logical (and, again, it is why there are people who are helping people who you have actively chosen to abandon). Somewhat amazing that you go onto criticise the US system for "overdiagnosis"...so no diagnosis is better than overdiagnosis? Again...you are a doctor, right? You are just saying: I would prefer to do no work at all than hard work. Feeble, and unbelievably arrogant (it is feeble to justify doing no work, it takes arrogance to criticise others for doing work). Truly, I hope this will help you. Stop. Think it through. Think whether what you wrote helps yourself more than other people. Btw, it is often very clear in these cases (and in life, generally) when someone is or is not lying because lying usually requires motivation (I have never come across someone who was obsessed with other people "lying" for anything other than self-interested reasons). Most people who have these conditions have their lives destroyed...to suggest that someone is motivated to destroy their own life is just stupid. To suggest that this must be the case to cover up your own personal failings (competence, lack of sympathy, ending up in a job that requires sympathy when you only possess avarice, etc.) is something far worse. EDIT: just to add actual info, because we are actually talking around some of the issues here...the UK uses the Oxford criteria for ME/CFS, this is a measure that was designed by psychiatrists, and has been shown to be a statistically significant treatment in samples selected using that criteria...one issue...all these studies have massive selection bias (some of these therapies wouldn't actually be possible for people with CFS/ME to undertake, imo) and the Oxford criteria wildly overstates incidence of ME/CFS (compared to Fukuda). The Lancet, a UK medical journal, continues to publish guidance that this is a psychological condition (again, not what is said above, that there are no biological pathologies...the Lancet is saying this can be cured by psychological therapy) despite the NIH (and others) showing that this is likely not the case (and suggesting that it is actually damaging research funding to suggest it is a mental condition).