Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Finding your own way to manage patients with functional disorders

Anton Emmanuel
Download PDF
DOI: https://doi.org/10.7861/clinmed.ed.21.1.1
Clin Med January 2021
Anton Emmanuel
Roles: Editor-in-chief
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

There is a high prevalence of patients with medically unexplained symptoms (MUS) in primary and secondary care settings. Persistence of MUS is common, with a study based in secondary care identifying half of all referred patients having no clear diagnosis yet have an associated impaired quality of life.1 Beyond the personal costs to these patients with functional disorders, there is accompanying impaired work productivity (approximated at £14 billion in the UK) and increased healthcare costs (estimated £2.9 billion to the NHS).2 The irony is that the need for a multidisciplinary approach integrating physical and mental healthcare services has been established for some time, but has proved elusive in practice. The articles in this themed edition of Clinical Medicine are directed towards helping the clinician find their own style of managing these common presentations, recognising the multi-system nature of the problem and finding their own way of understanding this and communicating it with patients.

But before that integrated approach is possible, the essential first step is to diagnose the patient accurately, and that is the theme of the first paper in the series.3 While the bravely written case report can be read as the description of an unusual condition, the deeper message is the importance of taking a history with an open mind, even if you are the third or fourth person to be seeing the patient with the same unexplained symptom. There follow two papers on the assessment of patients who remain symptomatic when an organic diagnosis has been excluded. The first highlights the importance of identifying pathological health anxiety, which often takes that most precious of commodities, time.4 The authors make a case for a nurse with psychological training to lead outpatient management of patients with functional disorders. This potentially provides easier access to psychological input as well as removing the often-perceived taboo of an external referral to a mental health professional. The second paper provides an excellent practical approach to history taking and information-sharing with the patient, adherent to a core principle of management – namely that patient self-care depends on having an accurate understanding of the condition.5

Chronic pain and fatigue are often the most troubling symptoms in patients with functional disorders, and commonly the ones clinicians have greatest difficulty in manging. Eccles and Davies explore the overlap with joint hypermobility and dysregulated inflammatory processes, and present the emerging evidence suggesting a neuro-immune basis to aetiology.6 The same group present some original data developing the theme of hypermobility in patients with fibromyalgia and chronic fatigue, identifying high rates of misdiagnosis.7 The edition also features a series of reviews from clinicians active in practice and research with this patient group, organised by clinical specialty.8–10 This may seem counter to the theme developed in the series of thinking in a multidisciplinary way, but these papers reflect the reality that patients are referred to physicians based on dominant symptoms. As such, while there are common themes that emerge in how patients are managed, what is also clear is the need to assess patients according to their presenting symptoms. These speciality-based papers all have a message to the naysayers about functional disorders – they point to aspects of aetiology that are distinctive and emerging in the literature.

Another paper in the theme is on the ‘hot topic’ of long COVID.11 More than one in ten individuals who get COVID experience chronic symptoms, hence this emergent diagnostic label; we have previously published on rehabilitation following infection.12 Now Ladds et al describe the particular opportunity presented by the proportion of healthcare workers who contracted the virus, and could potentially inform the agenda.11 Their paper forms a nice bookend to the series, highlighting the importance of multidisciplinary services as well as advancing the research agenda. We hope you find much here to instruct your practice.

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. Nimnuan T
    , Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialties. J Psychosom Res 2001;51:361–7.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Bermingham SL
    , Cohen A, Hague J, Parsonage M. The cost of somatisation among the working-age population in England for the year 2008–2009. Ment Health Fam Med 2010;7:71–84.
    OpenUrlPubMed
  3. ↵
    1. Keith T
    . ‘I can assure you, there is nothing wrong with your kidney.’ Clin Med 2021;21:4–7.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Tyrer P
    , Fox C, Gardiner C, et al. Initial assessment of patients with putative functional disorders in medical settings. Clin Med 2021;21:8–12.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Husain M
    , Chalder T. Medically unexplained symptoms: assessment and management. Clin Med 2021;21:13–18.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Eccles JA
    , Davies KA. The challenges of chronic pain and fatigue. Clin Med 2021;21:19–27.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Eccles JA
    , Thompson B, Themelis K, et al. Beyond bones: The relevance of variants of connective tissue (hypermobility) to fibromyalgia, ME/CFS and controversies surrounding diagnostic classification: an observational study. Clin Med 2021;21:53–8.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Rogers J
    , Collins G, Husain M, Docherty M. Identifying and managing functional cardiac symptoms. Clin Med 2021;21:37–43.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Bennett K
    , Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorders (FND) for the general physician. Clin Med 2021;21:28–36.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Fikree A
    , Byrne P. Management of functional gastrointestinal disorders. Clin Med 2021;21:44–52.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Ladds E
    , Rushforth A, Wieringa S, et al. Developing services for long COVID: lessons from a study of wounded healers. Clin Med 2021;21:59–65.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Wade DT
    . Rehabilitation after COVID-19: an evidence-based approach. Clin Med 2020;20:359–64.
    OpenUrlAbstract/FREE Full Text
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Finding your own way to manage patients with functional disorders
Anton Emmanuel
Clinical Medicine Jan 2021, 21 (1) 1; DOI: 10.7861/clinmed.ed.21.1.1

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Finding your own way to manage patients with functional disorders
Anton Emmanuel
Clinical Medicine Jan 2021, 21 (1) 1; DOI: 10.7861/clinmed.ed.21.1.1
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Rarely pure and never simple: interpreting investigation results in the clinical context
  • Transformation: fighting the past or building the new?
Show more Editorial

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians