Great question; thanks for asking. The main reason people with medically unexplained physical symptoms (MUPS) are resistant to psychological therapy is because, they have been victims of relentless medical gaslighting./1 🧵
https://twitter.com/EdanStarforth/status/1485974039436972037
In absence of obvious biomarker & return of normal test results, patients with MUPS are often incorrectly ascribed a psychological diagnosis. Psychologisation of MUPS has become commonplace, and it is not acceptable. It is important to consider:/2
(A) The absence of obvious biomarker does not mean one does not exist. Simply, it has not yet been identified./3
(B) The wrong test is being done. With reference to Long Covid, normal troponin, CXR & echo, do *not* exclude cardiac pathology, which is often only visible on CMRI. One cannot do a pregnancy test and tell someone they haven’t had a heart attack./4
Patients with MUPS are not reassured by the return of normal investigations. They often wish tests were abnormal just to be offered a reason as to why they feel so poorly & that something treatable is identified./5
(C) Normal tests - while reassuring - do *not* exclude pathology. Absence of evidence is not evidence of absence. Medics are often falsely reassured by tests which return NAD./6
To illustrate point (C), I will share with you a personal experience. Aged 10, I developed acute onset abdominal pain. I had multiple US abdo scans; all normal. Doctors told my parents it was attention seeking behaviour./7
My appendix eventually ruptured & I developed peritonitis and septicaemia. Aged 10, I weighed 2 1/2 stone. Medics, be suspicious of ‘normal’ tests eps when a patient tells you they are unwell. Investigations are not always specific or sensitive enough to pick up pathology./8
To answer your question, the refusal of patients with MUPS to to accept psychological support is a form of defence. They feel unheard and disbelieved./9
I find this heartbreaking. Because like any other serious physical condition, psychological diagnoses may appear secondary to the primary illness, and patients may benefit from being supported in this way./10
As a victim of medical gaslighting, I will share with you, it has caused medical PTSD trauma. One does not have to operate with great malice to cause harm, a lack of empathy is enough./11
Doctors *must* start from the premise that a patient is telling the truth. Trust between the doctor and patient is fundamental; without it, we have nothing. If a patient says they are unwell/ not right *believe them*./12
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