Copperfield on why he welcomes the Government’s recognition of overdiagnosis in mental health
Speaking as someone who has just been asked for a six-month sick note, straight off, by a patient in whom I’ve diagnosed ‘proportional sadness’ (aka normality), I’m delighted to hear Messrs Streeting and Kinnock talking about overdiagnosis in mental health. Primary care minister Stephen Kinnock actually doubled down on his boss’ original comments by announcing a crackdown on private sector therapists at Pulse LIVE.
Excellent. Though maybe we GPs should take some responsibility, too. We see numerous patients wanting minor personality traits to be diagnosed as OCD, bipolar or ADHD to validate their behaviour or simply to make themselves seem more interesting/edgy. They seem to think that the result of an online questionnaire from diagnoseityourself.com is definitive. It isn’t, and as per our filtering role with all other illnesses, we should be prepared to sift out the nonsense rather than collude with it. Clarity begins at home.
Of course, the problem is that many of these diagnoses are subjective, despite attempts by some to rubber-stamp them by misusing tick-box exercises like PHQ9 and GAD7. If you thought those were a tool for diagnosis rather than screening or monitoring exercises, see me after blog for some remedial work.
It’s a bit different with physical illness, which is another Pandora’s Box of overdiagnosis the politicians are very welcome to jemmy open. The thresholds for diagnosing, say, hypertension, diabetes or significant cardiovascular risk are objectively clear, which is fine, but those thresholds are subjectively set, which isn’t. And they’re being lowered all the time.
The result is spiralling prevalence and the pathologizing of risk. And the only ways to manage these are either to reset the thresholds and accept a handful more deaths for the sake of thousands fewer medicalised, or to embrace the inevitable and go down the polypill/we’re all pre-death road.
Whatever. Overdiagnosis is an underused word, and it’s great to hear it acknowledged, at last, by politicians, even if it’s only to cut the benefits bill. It has made me so psychotically happy that, according to the online questionnaire I’ve just completed, I may have mania. I probably should get that seen to, just as soon as I can get a sick note.
Dr Tony Copperfield is a GP in Essex
Difficult consultations are so much easier nowadays. The patients that used to have TATT or were just heartsinks can be dealt with very easily. I offer them an additional diagnosis as and when required.
Here is my cheat list. Fibromyalgia, long COVID, ADHD, ASD, post viral fatigue.
Investigate-all blood tests pertinent to QOF
Treatment-healthy diet, exercise, no smoking, no alcohol , less mobile phone use.
Referral-to adult ADHD/ASD clinic or long COVID clinic. Whichever has the longest wait.
Purely as a GP, and to the contrary, my great worry is the Underdiagnosed epidemic of mental health in politicians and their mates. Excuse the cod Latin (my OLevel was decades ago), but Tony have some sympathy for the dears who suffer with Loquare faecalis major, chainsaw psychopathy, Psychocidalum WMD disorder, Cranio Lettucum patheticus, Coprophagus Boris-ninny, mayflatus wheat syndrome, Ophthalmitis barnardii, schizoanalis nondom trait, etc etc.
Can someone please section them to the care of Nurse Ratched, ECT and pentothal. And surely give our “betters” their billions in bailouts, subsidies, tax breaks, sinecures, allowances, perks, moats….oh, and state benefits 🙄
For years Primary Care has cheerfully colluded with those presenting symptoms in pursuit of gain; for perfectly understandable reasons, as those self-diagnosed as disabled are usually very able to manipulate the multiple options to complain and make life unpleasant for GPs.
The consequence however is that around one in every eight adults receives a disability benefit. Imagine what the NHS could do with the £140 billion, doubling it’s entire annual pre-COVID budget, that is currently paid to working age adults to sit at home and watch daytime TV.
last time I dared to disagree with a customer, arguing he was not depressed just moody, next morning I recieved a letter from AE from admission with DSP by 3 or 4 ibuprofen tablets. this followed by safeguarding and complaints. I have learnt my lesson and will never dare to express any opnion on anything that affects disability, benefits, sick pay.