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