This recent article in JAMA Neurology, authored by Dr. Matthew J. Burke, shines light on an ongoing and increasing epidemic in our medical world. Patients with serious neurological complaints (especially if they already carry a psych-related diagnosis) are termed "non-organic" or functional neurological cases - or, even worse, just plain crazy.
Not long ago I saw a patient, with a prior history of well controlled depression, admitted to the hospital with multiple seizures that they diagnosed as "panic attacks.” Clearly, these were not panic attacks. I am continually astounded at what patients are told and how they are treated when presenting with symptoms that are not immediately attributable to a specific disease.
"The inadequate management of this segment of medicine represents a silent epidemic that is slowly eroding patient-physician relationships, perpetuating unnecessary disability, and straining health care resources," stated Dr. Burke. I couldn’t agree more.
I honestly don't believe a diagnosis of functional neurological syndrome should be made until all evaluations are done through the lens of integrative medicine including comprehensive lab work testing for biomarkers of inflammation as well as evaluating gut health, determining the toxic load and other influences and employing new imaging techniques like NeuroQuant. In other words, we must first use all our resources first to ensure we aren’t overlooking significant signs of any condition before considering the cause of our patients’ distress is “non-organic.”
It’s no wonder there are several television shows now, such as the popular Diagnosis series on Netflix, featuring extremely perplexing medical cases that didn’t necessarily present with obvious clues. We as a profession need to be more open to what patients experience and be cautious about dismissing - or missing – any condition that is potentially serious.
Story and video about Diagnosis at https://www.nytimes.com/2019/07/22/magazine/diagnosis-tv-netflix-lisa-sanders.html
Source: Matthew J. Burke, MD, FRCPC
JAMA Neurol. 2019;76(12):1417-1418. doi:10.1001/jamaneurol.2019.3043