Patient discussions
Education and explanation of the diagnosis is the first step of management for both conditions. It is important to acknowledge the reality of the patient's symptoms and of their physical and emotional suffering. Take sufficient time, give the name of the condition, and provide further reading and support information. An empathetic approach is key, but note that even when the diagnosis is presented with care, some patients will respond with anger, humiliation, or distress. Follow-up explanations by other members of the multidisciplinary team in primary and secondary care may be useful.
For functional neurological disorder, demonstrate positive clinical signs to illustrate the underlying mechanisms involved.[101] The aim is to provide validation of the patient's symptoms, and to offer a confident diagnosis that negates the need to seek an alternative medical opinion.
When giving a diagnosis of functional neurological disorder, useful phrases to adapt may include:[71]
"Functional neurological disorder is a problem with the functioning of the nervous system. It's a problem with the software rather than the hardware."
If this explanation is not fully understood, an alternative may be: "It's like a piano that's out of tune; not broken, just not working properly."
Although often ultimately the goal of treatment may be good management rather than cure, it may nonetheless be helpful to emphasise to patients from the offset that complete resolution of symptoms is possible. A useful way to describe prognosis could be: "This is not an easy problem to put right, but it does have the potential to improve, and many people do make a good recovery."
Before delivering a diagnosis of somatic symptom disorder, carefully explore what the patient thinks is wrong, and tailor the explanation accordingly.[145] One approach to giving the diagnosis is to explain that there is no evidence of a serious or life-threatening illness, and to emphasise that this is positive news. The explanation may include: "You have a condition that is common but not yet fully understood, which we know to cause the group of symptoms you are experiencing."
When presenting the diagnosis to patients, explain that stress and psychological factors are known to influence physiological changes and physical symptoms. Although asking about adverse life events may help with treatment planning, be sensitive to the fact that it may cause distress and can be perceived as intrusive and inappropriate, especially if there is a history of previous interactions with healthcare professionals that explored this and which were viewed negatively by the patient. Follow the patient's cues, and proceed sensitively; consider whether it may be better for this discussion to wait until a follow-up visit.[66]
Emphasise the importance of adherence to psychotherapeutic and pharmacotherapeutic management. Self-help workbooks used alongside guidance from the care-provider can be beneficial.[108][166] Direct patients to appropriate support websites. neurosymptoms.org: FND guide Opens in new window FND Hope Opens in new window
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