Supporting People with Medically Unexplained Syndromes

is Professor of Psychology as Applied to Medicine at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK. She is a keynote speaker at this year's in Oxford.

 

I am delighted to be presenting a keynote talk to the upcoming SAPC conference on a topic very dear to my heart. My interests in this area began as long ago as 1988 when I moved from South Africa to take up a post in a small East Coast town in New Zealand. One of the first patients referred to me, let’s call him Mr X, had a mysterious illness called Tapanui Flue. A previous high level athlete and school teacher, he was experiencing overwhelming and disabling fatigue. So there I was, new kid on the block in a strange country, faced with a condition I had never heard off and a very distressed patient. Still to this day I regret the fact that I wasn’t much help to Mr X. I subsequently learned that he more than likely had CFS/ME and so began my research career. 25 years later I am confident that if I knew then what I know now – I could have made a difference to this patient. However, many of these patients are still failed by our current system, and I hope to elucidate in my talk on Thursday as to why this might be.

CFS/ME is one of many conditions falling under the broader umbrella term 'Medically Unexplained Syndromes' or MUS. These conditions are characterised by persistent symptoms, suffering, and disability which cannot be explained by disease specific, measurable abnormalities.   If you are a practising GP in the UK, recent estimates suggests that these patients are around 18% of your caseload.   They cost the national health system in Britain £3.1 billion per year. They also have immense personal costs including sickness absence amounting to around £14 billion annually. It shouldn’t cost this much either to the patients or the health system – so where are we going wrong?

Perhaps the starting point is in the term. Patients come to us because they want a positive description of symptoms i.e. an explanation of what the illness is rather than what is isn’t. MUS are defined by what they are not: i.e. the term implies no organic cause. It also provides no direction for future treatment. We need a better label to move forward in this area.   We also need positive descriptions of why people have these symptoms. In my talk I will provide examples of these and how they might be incorporated into everyday primary care.

I will also argue that the practice of medicine is still embedded in the biomedical rather than the biopsychosocial model proposed by George Engel almost 30 years ago. Patients without a clear biomedical explanation of their symptoms are often left feeling misunderstood and legitimised by the heath service. I will present data from some our work showing how MUS are best understood in terms of biopsychosocial models.   I will also show why conceptualising MUS as somatised depression or anxiety is often inaccurate and unhelpful.

Finally, I will provide a brief overview of the current evidence of best treatment for this group of patients. I will present a matched care model of treatment we have developed for the NHS England Improving Access to Psychological Therapies (IAPT) programme. As part of this programme we have also recently published specified clinical competence in this area. The next step is specified training programmes. Watch this space.

The 44th runs from Wednesday 8th to Friday 10th July 2015