Can internal medicine specialists diagnose functional somatic disorders (FSDs)? Training and comparison with FSD specialists

Abstract

Background Functional somatic disorders (FSD) are a common problem across medical settings and remain challenging to diagnose and treat. Many patients with FSD undergo sequential and unnecessary extensive diagnostic work-up, which is costly for society and stressful for patients. Previous studies have shown that the empirically based FSD diagnostic entities are interrater reliable and stable over time. Objective The aim of this study was to investigate whether internists who have received adequate training and with sufficient time per patient could diagnose FSD. Design This was a prospective diagnostic accuracy study. The study was conducted from May 2020 to April 2022. Participants The study included 27 consecutive patients referred by their general practitioner to a non-psychiatric diagnostic clinic for assessment of physical symptoms on suspicion of FSD. Interventions The internists received a 30-hour training course in the use of a tailored version of the SCAN interview. Main measures The main outcome measure was the agreement between the diagnoses of the internists and the reference diagnoses made by specialists in FSD on the basis of the full SCAN interview. Key results The interrater agreement between the internists and the FSD experts was substantial for any FSD (kappa = 0.63) as well as multi-organ vs. single-organ FSD (kappa = 0.73), indicating good diagnostic agreement. Conclusions Internists with proper training and sufficient time (3–4 hours) per patient can proficiently diagnose FSD employing a tailored version of the SCAN interview for use in a non-psychiatric diagnostic setting.