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1. This is a very useful thread #MedTwitter because it tracks common reasoning errors that lead doctors to readily accept psychosomatic dx for #MEcfs and other contested conditions like #EhlersDanlos, #mito, #dysautonomia, #LymeDisease, etc.
2. Start with the duty that defines your profession @strauss_matt - to ensure that every patient with a need for med care (medical testing, treatment, or support) receives it when she seeks it from you. Mistaken psychosomatic dx violates that duty in every case where it occurs.
3. No doctor should have to be told to err on the side of medical caution. Your job requires (a) humility about the limits of dx science and (b) historical awareness of immense suffering caused by psychological explanations for #MS #epilepsy #PepticUlcer #Parkinsons #lupus etc.
4. Psychosomatic dx is not benign. Misdx obstructs access to med care for patients in need – and that is a harm you are pledged to avoid above all others. Further, you do harm every time you lead a patient to feel psychologically responsible for a biological disease.
5. Medicine isn’t just about finding the right answers. It’s about asking the right questions. “Can you prove condition X is not psychological?” is always confused because psychosomatic dx can't be falsified. That’s why philosophers of science see it as paradigm for pseudoscience
6. On #MEcfs: It’s your job to know that the Nat Ac of Sciences, NIH, CDC, HHS have examined the biological research and have each reversed the conclusion that it’s psychological. It’s fine to be a novice, but if you are it’s unreasonable to publicly challenge that conclusion.
7. This paper of mine spells out clinical & ethical problems with “prove it’s not psychological” in a way that applies to all contested conditions with substantial debate about biological causes, like #EhlersDanlos #mito #POTS #LymeDisease etc #MedTwitter onlinelibrary.wiley.com/doi/full/10.11…
8. You might also find this one useful. It examines reasoning errors in management of medically unexplained symptoms, and the clinical and ethical harms they routinely cause. #MedTwitter tandfonline.com/doi/abs/10.108…
