Thread by @cjwilde

Ben Symon @symon_ben presenting on functional neurological disorders. #DFTB22

Functional neurological disorders

Need to get people off the investigation bandwagon. And share some compassion.

Ben tells the story of a child who had apparently suddenly blindness, he demonstrated they weren’t blind, child discharged.

Child has unrelated presentation 6 months later. Family describe history of transient blindness, normal MRI. @symon_ben feels he didn’t contribute to the care of this child after all.

The sick role
When someone doesn’t seem upset about their sickness, we might punish them - waits, unhelpful advice.

We all have emotional needs
Clapping the pandemic heroes - was that for HCWs or to reassure the people at home facing a life-threatening risk?

Doctors have emotional needs
We fix people
We don’t get damaged ourselves
Do we avoid functional neurological disorders because we can’t fix it immediately?

Foccault’s clinical gaze
Systematic dehumanisation of our patients
bjgp.org/content/63/611…

What do patients need?

We need to be able to talk to patients and parents honestly about what we see and know.
It’s going to be a long journey.
HCWs to have the education and support to manage these complex presentations effectively and compassionately. #DFTB22

Question regarding how to give a graceful exit.

Ben’s experiences:
Seizures have stopped after holding patient hand and reassuring safety.

Seizures have stopped after compassionate comment it must be really hard with parents fighting all the time.

“We’re going to check balance.” Check gait walking past parents, while away from parents, while talking about #Bluey. Document it clearly. Discuss it and seek the reasons.
#DFTB22

“I’m going to be honest with you, I think all these tests will come back normal, and this is why:”
…
“I don’t want you to wait until you’re much later in your journey with another specialist before you hear this for the first time.”

We are obsessed with an end-diagnosis as opposed to “what do you need right now on your path to help you heal?”

There are things we can do, even if we aren’t psych specialists.

Feedback from the floor - don’t forget the GPs.

Also a compliment that this GP has noticed kids with FND coming out of a local hospital feeling more validated.

Thanks @symon_ben for sharing your insights!

#CompassionateCare
#DFTB22