Table 2

Features of some common explanations offered by neurologists to patients for functional disorders and their associated problems

1. Making no diagnosis: no neurological disease (includes the term ‘non-organic’)The patient is likely to go elsewhere to seek a diagnosis
2. Making an ‘unexplained’ diagnosis, eg, these things are common in neurology and we don't really know why they happen
  • The patient is likely to go elsewhere to seek a diagnosis

  • Many neurological disorders have known pathology ‘unexplained’ or ‘unknown’ cause, eg, multiple sclerosis/Parkinson's disease

  • Neurologists should be familiar with functional disorders and be able to make a positive clinical diagnosis, eg, migraine/Parkinson's disease

3. Making an incomplete diagnosis—eg, telling someone with a 3-week history of functional hemiparesis triggered by migraine that they just have migraine39This may be acceptable to the patient (and be easier for the neurologist) but leads to a missed opportunity to understand symptoms and their potential for reversibility
4. Trying to explain that the problem is psychological—eg, explaining that these symptoms are often ‘stress-related’
  • Likely to be rejected by most (80%) of patients

  • Often equated by patients as an accusation that the symptoms are ‘made up’ or ‘imagined’

  • Many patients with these symptoms do not have identifiable stress or psychiatric disorder

  • This is, however, consistent with referral for psychological treatment

5. Making a functional diagnosis
  • Consistent with a disorder of nervous system functioning

  • Does not leap to conclusions about the cause

  • Could be interpreted as something irreversible that cannot be improved with physical or psychological rehabilitation.