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“Functional disorders”: one of medicine’s biggest failures

BMJ 2023; 380 doi: (Published 27 January 2023) Cite this as: BMJ 2023;380:p221

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Re: “Functional disorders”: one of medicine’s biggest failures

Dear Editor,

An excellent and succinct commentary on 'Functional Disorders', one of the challenges in clinical practice where 'ruling out' becomes an extensive and laborious exercise, more so in an era of patient because of the consumer redressal and litigation(s) that may follow. Viewed broadly and wisely, the mind - body relation is inseparable. Unless one makes an obvious and spot diagnosis looking at the appearance, face, gait, movement; unless a wide spectrum - laboratory, imaging assessment is done, 'hypochondriasis' as a diagnosis may be difficult to make. There cannot be any bigger blunder than a ' functional' turning out and emerging to be 'organic', sometimes damaging the reputation so assiduously built. The best approach is therefore, making a 'diagnosis by exclusion' unless anxiety, panicare the only presenting symptoms, observed over sufficient time.

Whether COVID-19 pandemic has added to and aggravated the psychosomatic scenario is a moot question, but the answer is more likely to be in the affirmative; frenetic lifestyles, day-night blurring, 24/7 living linked sleep deprivation and drugs - psychedelics have been known factors before the pandemic. Psychiatrists have helped resolve many problematic situations, and their role deserves to be rightfully acknowledged.

Dr Murar E Yeolekar, Mumbai

Competing interests: No competing interests

30 January 2023
Murar E Yeolekar
Consultant Physician
Fmr Prof & Head of Internal Medicine, KJSMC&LTMMC
Sion, Mumbai 400 022.