Patients whom neurologists find difficult to help
Open accessAbstract
BACKGROUND: All doctors recognise that some patients are more "difficult to help" than others, but the issue has received little systematic investigation in neurological practice. OBJECTIVE: To test the hypothesis that patients whose symptoms were less explained by organic disease would be perceived as more difficult to help. METHODS: In a consecutive series of 300 new neurology outpatients, neurologists indicated on four point Likert-type scales how "difficult to help" they found the patient and to what extent the patient's symptoms were explained by organic disease. The patients' demographics, health status, number of somatic symptoms, and mental state were also assessed. RESULTS: The neurologists rated 143 patients (48%) as "not at all difficult" to help, 111 (37%) as "somewhat difficult", 27 (9%) as "very difficult", and 18 (6%) as "extremely difficult". A logistic regression model was constructed and the hypothesis that patients whose symptoms were less explained by organic disease would be perceived as more difficult to help was supported. The only other measured variable that contributed to perceived difficulty was physical disability, but it explained only a small amount of the variance. CONCLUSIONS: Neurologists find patients whose symptoms are not explained by organic disease more difficult to help than their other patients.
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When the new diagnosis is a functional disorder, the neurologist may feel less equipped to help than with an MS diagnosis.
“This is perhaps especially the case when the new diagnosis is one of a functional disorder, when the neurologist may feel less equipped to help than they were with an MS diagnosis [58].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [58]
The Results report that neurologists rated patients with symptoms poorly explained by organic disease as more difficult to help than those with fully explained symptoms. The paper lists multiple sclerosis among the diagnoses in its sample, but it does not specifically compare functional-disorder diagnoses with MS diagnoses or assess how equipped neurologists felt to help each group. (LLM, conf=0.84)
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Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (2013) · PsycTESTS Dataset · doi:10.1037/t03589-000 · Cited by 946 · see citing works
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Functional neurological disorders: The neurological assessment as treatment
Stone, J. (2016) · Practical Neurology · doi:10.1136/practneurol-2015-001241 · Cited by 157 · see citing works
Walzl, D., Solomon, A. J., & Stone, J. (2022) · Journal of Neurology · doi:10.1007/s00415-021-10436-6 · Cited by 62 · see citing works
- Authors
- Carson, A. J.
- Affiliations
- Royal Edinburgh Hospital (GB)
- Corresponding author
- Carson, A J
- ORCID
- Carson, A J
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2004-12-01
- Volume
- 75
- Issue
- 12
- Pages
- 1776-1778
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC1738867
- OpenAlex
- W2122131229
- Cited by
- 105
- References
- 1
- Citations by year
- 2025: 2 · 2023: 2 · 2022: 4 · 2021: 41 · 2020: 1 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 8 · 2014: 3 · 2013: 3 · 2012: 4
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- University of Edinburgh
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Keywords
- difficult patients, organic disease, physical disability, somatic symptoms, mental states, patient-clinician relationship, neurology outpatients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Diagnosis, Differential, Female, Health Status, Humans, Male, Middle Aged, Nervous System Diseases, Neurology, Outpatients, Physician-Patient Relations, Prospective Studies
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