Frustrating ☹️
A European subsidy of €4 million for a Dutch study on what they call "functional complaints" incl. #CFS.

"Some people particularly benefit from physical therapy, while others are more in need of support from a psychologist."

#MUS
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https://www.dvhn.nl/groningen/Als-de-dokter-niks-kan-vinden-25856002.html

Two out of three patients cannot be diagnosed at the outpatient clinic for internal medicine at the UMCG
Inki the Younger • Today, 05:25 • Groningen
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Judith Roosmalen (right) and Marina de Koning-Tijssen. . Professor and neurologist UMCG conduct research into medically misunderstood physical complaints. Photo: Corné Sparidaens

You feel sick, but the doctor doesn't know what it is. The specialist cannot find anything either. Then there is a good chance that you suffer from so-called functional complaints. In conversation with medical biologist Judith Rosmalen and neurologist Marina de Koning-Tijssen of the UMCG.

The doctor knows everything? He taught on for it. If you are ill, you go to the consultation hour, where a diagnosis is made, a medicine is prescribed and the complaint disappears. Do you think.

But the doctor doesn't know everything. He can refer to the hospital, but there too they regularly have to remain guilty of the answer. There is a chance that the patient will have to leave the doctor's office or outpatient clinic, disappointed and worried, because his complaints are not understood.

Very often no explanation is found

And that chance is quite high: no explanation is found in about half of the number of GP visits. Two out of three patients cannot be diagnosed at the outpatient clinic for internal medicine at the UMCG. They belong to the group of people who suffer from misunderstood diseases, in medical terms: Somatic Inadequately explained Physical Complaints, also known in the Netherlands as Solk, or 'functional complaints'.

"It is the most expensive health problem, after dementia," says Judith Rosmalen, professor of psychosomatics at the University of Groningen. Last month it was announced that Rosmalen can count on a European subsidy of 4 million. She will be conducting an international research project together with neurologist Marina de Koning-Tijssen. An interdisciplinary study that maps Solk's mechanisms, aims to improve diagnosis and treatment, and reduces stigma.

No explanation? Then you are not sick in the eyes of many

Those who hyperventilate, have a tension headache, suffer from low back pain or an irritable bowel, who suffer from chronic fatigue syndrome, or have unexplained movement disorders, will be able to confirm it: if the doctor has no explanation for the complaints, you are in the eyes of many not sick.

Functional complaints are systematically ignored and downplayed, according to Rosmalen and De Koning-Tijssen. Not only at the birthday party, where friends and family members suggest that it is probably 'in the ears', but also in the doctors' consulting rooms, who often find the subject difficult to discuss.

Doctors cannot know and measure everything in medicine. There is doubt. There are new insights. Rosmalen and De Koning-Tijssen once again realize the importance of paying attention to functional complaints. "I sometimes ask during lectures: who thinks multiple sclerosis is a disease?" Then almost three-quarters of those present raise their hands, '' says Rosmalen. "Then I ask if the chronic fatigue syndrome is a disease, then a finger goes up here and there."

A 'vague complaint' is not a serious problem

This says a lot about how the medical world views these things. It is a 'vague complaint', so not a serious problem. De Koning-Tijssen: ,, Colleagues often say what it is not, but the patient wants to know what it is. I discuss with my patients that they are diagnosed with functional movement disorders based on certain criteria, and I also discuss those criteria with them. ''
They know amazing examples of medical bias. The radiologist who talks in a national newspaper about 'pain here, pain there patients' who 'actually know that they do not need a doctor' and increase the healthcare costs. The lecture by the company doctor who tells his audience in tasty anecdotes tells how he tries to expose his patients by spying in the waiting room whether they still show the same complaint picture. Rosmalen: "So if you are a patient with misunderstood complaints that you cannot help well with, then you also have to fight against these kinds of prejudices."

In an earlier opinion piece in Trouw , she argued for more attention to the matter: "Misunderstood complaints are not so different from understood complaints," Rosmalen said. 'The characteristic difference is that, including complaints, a medical deviation has been measured, which means that there are sometimes more specific treatment options. Furthermore, there are mainly similarities: complaints and limitations are strongly related to social and psychological factors, both included and misunderstood complaints. '

Misunderstood patients also deserve care and guidance

Understood or misunderstood: in both cases patients deserve good care and guidance, say Rosmalen and De Koning-Tijssen. Although research shows that misunderstood complaints often pass again, some of these people become chronic patients.

Both women have extensive experience with research into functional complaints. A few years ago, Rosmalen, professor of psychosomatics, designed 'Grip'; an online system that supports both patient and healthcare provider. As head of the rare movement disorders section of the neurology department, De Koning-Tijssen regularly has to deal with tremors and body shocks that no one can explain.

To break through such a problem, doctors, physiotherapists and psychologists must work closely together. Customization is of great importance. De Koning-Tijssen: ,, As a doctor, you have to think outside the box. What is good for this patient in this situation? For example, some people suddenly cannot walk properly anymore. Often they have unconsciously learned that along the way. If they then walk backwards or walk in certain forms under the guidance of a physiotherapist, that nervous system is controlled in a different way. You actually learn to walk again. That can work well. But you have to see what is good and what is not per patient. ''
“Dealing with these complaints is custom work. Some people particularly benefit from physical therapy, while others are more in need of support from a psychologist. Serious or long-term complaints often involve more healthcare providers, '' says Rosmalen.

It is necessary that young doctors, care providers, as well as scientists, realize functional complaints and are aware of the need to take this seriously, in the opinion of Rosmalen and De Koning-Tijssen. The European-funded research, in which 15 PhD students will participate next year, has the important aim of training and informing that young profession. So that the professionals of tomorrow, who will not always know, will not send the patient into the reed with clods of incomprehension and will also confront the 'vague complaints' with serious medical attention and research.

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