MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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“Professor Peter Salmon (University of Liverpool) talked about the patients’ beliefs regarding their medically
unexplained symptoms and the implications for diagnosis and treatment. Whilst some sympathy was expressed for the
general practitioner….the conclusion seemed to be that symptomatic interventions are inappropriate.
“Professor Derek Wade (University of Oxford) gave a lecture entitled ‘Enablement: Remarketing Socio‐medical
expectations in Rehabilitation’. Enablement is the new alternative word to rehabilitation and I think it’s
really going to take off.
“Professor Kim Burton (Huddersfield) emphasised the importance of psychosocial factors in maintaining persistent
symptoms and disability and how these can be identified. The role of inappropriate or erroneous beliefs held by
patient and practitioner are important obstacles to recovery”.
2005
The Report of Dr Michael O’Donnell, Chief Medical Officer of UNUMProvident (“Evolving: the way we
look at claims”), states:
“In everyday life, all of us experience symptoms of one sort or another….What determines how a person reacts to a
symptom…?
“In the past it has been considered that medicine alone could supply the answer about how to measure
incapacity….There are many… examples of how the medical model of disability fails to fully explain incapacity.
“The Biopsychosocial (BPS) model attempts to take a holistic view of incapacity and disability…We know that…factors
such as…beliefs about causation…are more important predictors of long‐term absence…
“We are now finding that as we better understand the BPS model (our current claims team structure) may be impeding
our ability to manage claims in the best possible way….With effect from 07.11.2005…we shall have psychiatric
expertise much more readily available to all CMCs (Claims Management Specialists). This will enable us to identify
much more readily those cases where …psychiatric illness lies behind or complicates the medical presentation of
incapacity.
“At UNUMProvident, we believe that we have always been at the leading edge of disability assessment and
management.
“We know that our views and understanding are not yet in the mainstream of doctors’ thinking, but Government
Policy is moving in the same direction.
“It will not be many years before the rest of medicine follows our lead”.
2006
In the next UNUMProvident report in the same series (“Enabling: a holistic view of health”) Michael
O’Donnell reiterated the same message and emphasised how much UNUMProvident had learnt from
academic colleagues at the UNUMProvident Centre for Psychosocial and Disability Research at Cardiff (ie.
from Mansel Aylward):
“In a previous publication (Evolving, November 2005) we told you about changes (that) reflect the knowledge we have
gained at UNUMProvident about the complex interactions between ill health and behaviour.
“We believe that the biopsychosocial model of disability provides a complete view of illness, sickness and disease.