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Illness as a career choice

    The author is a physician with a practice in the North-West.

    It is vital that those suffering from disabling health conditions are well supported by the welfare system. However it is my belief that in some cases well-meaning welfare provisions can end up having severe unintended consequences.

    As a physician I have previously worked in areas with a broad range of demographics and have seen the various stimuli that lead to and from ill-health. A fact that many on the inside, but few on the outside know is that a common driver to ill health is the welfare state. In short, it appears that being sick has become a way of life and a career choice for a worryingly high percentage of the population.

    Disability benefits have the potential to inadvertently encourage a state of dependency, and incentivise an individual to remain sick. Two patients can have identical pathology – for example identical objective deficits from multiple sclerosis – but with striking differences in illness behaviour. It its current form the welfare system is prone to misuse.  For those in legitimate need, disability benefits can enable them and restore livelihood. For others however disability benefits can incentivise work avoidance.

    But how extensive is the problem? How can a doctor tell if symptoms are being exaggerated? We are advised in medicine not to use the word malingering, but rather ‘subconscious amplification of symptoms’. It can be very difficult to know how much is subconscious and how much is amplified. One informal survey of colleagues from around the UK placed the figure at between 10% and 90%. Interestingly, if the question is restricted to doctors working in areas of high unemployment then a much higher figure is reached. This is of course not surprising as the alternative prospects for individuals are far more limited.

    As an illustration, an intravenous drug user I once saw had lost use of his arm because of a drug-related incident. When I told him that he would not recover the function of his arm I was expecting great disappointment, but instead got the surprising reaction, “great, does this mean I will get benefits?”

    When the disability reassessments were introduced a couple of years ago many colleagues saw a sudden and unexpected worsening in patients symptoms. Patients who previously had well-controlled epilepsy reported more seizures or that their pain had worsened. As well as costing the system, it also makes the doctor’s role difficult in trying to judge what is true illness and what is amplified, leading to more investigations, more hospital appointments, more drugs.

    Such over-dependency can have a distortionary effect on the wider economy. Individuals on chronic welfare increasingly move from the affluent South-East to the North because there is a greater availability of social housing, and living costs are lower. In contrast, talent migrates from the North to the South-East because of better prospects. This then compounds the situation. It is an interesting observation that the area of the country with by far the lowest per capita spend on infrastructure, the North-East of England, has the highest welfare spend. In effect, successive government policy has attempted to enforce a deal on the population of providing the South with the investment and tools to generate the returns and then transfer some of this to the north in welfare payments. In crude terms, investment follows place (South), welfare follows people (North).

    More importantly, over-dependency is not good for the individual. They become locked into a way of life with reduced well-being, and the attendant inactivity for many patients leads to further illness and obesity. Most significantly, I have observed that not working can result in a loss of sense of purpose, of personal value of being in a team.

    Not only does the current welfare system incentivise false claims, it can also overlook legitimate ones. Many doctors have patients who they think deserve benefits yet don't get them. Or the receipt of benefits is unacceptably delayed.  Thus there is a mismatch between patients on long-term benefits driven by the financial incentives of the system and becoming less employable, but other patients who we desperately want to get better and faster support. In essence, the disabled are suffering from the actions of others.

    Why does the assessment system not weed out such cases? Firstly, I believe that welfare assessment should focus on what can be done, not what can’t be done. The ability to accurately assess disability and levels of dysfunction can be very difficult. In some cases even skilled physicians with decades of experience can get it wrong. The inaccuracy that results is compounded further by the current assessment procedure, which pressures physicians to not be entirely open. This is because the patient can review the report before it is sent off for approval. A doctor’s performance is determined by their patient throughput and number of complaints received. Thus by conceding to a patient’s expectations a doctor can avoid a potentially hostile confrontation and complaints on their record. Indeed the degree to which patients can pursue doctors who do not give them what they want is so great now that once one has been bitten, the easy option is much more likely to be followed.

    In this regard I believe the views of the ex-head of the NHS litigation authority were shockingly naive when he stated that if we eliminated errors there would be no complaints. In reality the relationship between errors and complaints is surprisingly shallow.

    Some doctors will provide diagnostic labels which provide a potential ticket to benefits, which if examined closely are part of the normal spectrum. A common example I see is patients being diagnosed with joint hypermobility syndrome with associated pain. When does a flexible patient become hypermobile, and why does this lead to some developing chronic pain and on benefits? Or take depression, which affects 1/3 of the adult population at some stage. There is a big difference though between someone needing sectioning and ECT, and someone needing citalopram and a bit of cognitive therapy.

    Proposals:

     1. Doctors reports should be anonymised and made confidential. The current forms are better than the previous ones, but need support from non-assessment service doctors and this will work best if those doctors can be open and frank.

     2. Illness/disability benefits assessments should be designed to identify activities which an individual can do, not what they can't do. The Government must encourage the full range of mental, physical and social activities. For example, if an individual took extra welfare support for one domain, they would be required to utilise other domains. e.g., if a patient were wheelchair-bound but had full mental faculty then financial support would be provided to assist with mobility only if they were active in terms of work (even if only voluntary work) that required their mental faculties or social engagement. Conversely an individual with mental health problems and unable to function in a stressful work environment could be supported in using their physical abilities, for example with manual work or even befriending lonely elderly individuals.

     3. For conditions which can be ameliorated by the action of the individual, greater emphasis should be placed on determining the right balance between disability payments and programs that emphasise greater personal responsibility for recuperation.

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    Comments

    Kaliya Franklin - About 1379 days ago

    It is extremely troubling to see that the author of this piece cites 'hypermobility' as a potential diagnosis gateway to benefits.

    This demonstrates a lack of understanding on the author's part not only of the latest research about inherited connective tissue disorders and how they differ from 'normal hypermobility' in their role as a physician, but also ignorance of the DWP's own information provided about such conditions in relation to benefit eligibility. This information is easily and freely available, routinely used by DWP decision makers and authored by the international expert in JHS/EDS Professor Rodney Grahame. Professor Grahame is a previous chair of the medical advisory board for DLA/AA. The difference in the spectrum of hypermobility and its potential disabling impact is clearly outlined in the first two paragraphs of the DWP information.

    https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/321674/a-z-adult-medical-conditions-jun-14.pdf

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    Moggy PL - About 1379 days ago

    If you're anything like me you'll be climbing the walls by now with that over-used phrase so loved by the ConDems and the media - and physicians it would see,: welfare dependency. We need to challenge and expose some of these nonsense soundbites for what they are.

    Think about that expression 'welfare dependency' for a moment. When you analyse it you realize it's the most ridiculous expression on earth. I mean what is normally meant by welfare? What do you understand by it? I understand it to mean looking after the health and well-being of my fellow human beings. Dictionary definitions will say 'the health, happiness, and fortunes of a person or group' and 'statutory procedure or social effort designed to promote the basic physical and material well-being of people in need.'

    So being dependent on that or at least that concept is a good thing, isn't it? Of course, successive governments are using it to mean 'benefit dependency' but again, put this phrase under scrutiny and its absurdity is all too evident. Benefits are only, after all, the means to living, eating, clothing, shelter, warmth. Show me a person who isn't dependent on these things. Are MPs, CEOs, bankers, physicians, or any other wealthy individuals you care to mention somehow immune from this sort of dependency? Of course not.

    Successive governments are using the phrase 'dependency' in the sense of addiction, with all its negative connotations. If you think about it, it is actually the wealthiest in society who are more 'addicted to a culture of dependency' - a phrase governments, and especially the Coalition, like to bandy about a lot. Can it be called dependency at all when it is essential for living?

    Let's face it, if we substitute the word 'welfare' for the one of 'oxygen' - (we're all oxygen-dependent ) - we expose the phrase for its utter stupidity.

    Last night there was a programme on ITV3 'The Secrets Of The Workhouse'. One of Brian Cox's ancestors had a brain injury and another sort of disability but he was in the lowest category for the workhouse - Class 10 - 'the malingerers'. Yes, that's right, he wasn't believed even though he was disabled. Brian Cox was outraged at the human indignity. What Brian Cox didn't realize that this exact pernicious thinking still permeates this rotten system today. Which is why I support a Citizen's Income where work is defined in the widest possible sense: voluntary work, the arts, education, caring, bringing up children are all valued 'careers' and where everyone is valued for their contribution to society.

    Sam Barnett-Cormack - About 1379 days ago

    The author is entitled to their opinion. I disagree with a great deal of it, and think that anecdote is presented as more authoritative than is reasonable, but the author is entitled to their opinion.

    However, it is rank intellectual dishonesty for CPS to present this as some sort of significant evidence in an ongoing debate that gives fuel to people harassing disabled people - I know people who have been harassed by strangers with taunts and threats based on the idea that they are 'faking' to get benefits. The way this piece has been presented on social media by CPS is intellectually dishonest and socially irresponsible.

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    Anonymous - About 1379 days ago


    If you're anything like me you'll be climbing the walls by now with that over-used phrase so loved by the ConDems and the media - and it seems - some physicians: welfare dependency. We need to challenge and expose some of these nonsense soundbites for what they are.

    Think about that expression 'welfare dependency' for a moment. When you analyse it you realize it's the most ridiculous expression on earth. I mean what is normally meant by welfare? What do you understand by it? I understand it to mean looking after the health and well-being of my fellow human beings. Dictionary definitions will say 'the health, happiness, and fortunes of a person or group' and 'statutory procedure or social effort designed to promote the basic physical and material well-being of people in need.'

    So being dependent on that or at least that concept is a good thing, isn't it? Of course, successive governments are using it to mean 'benefit dependency' but again, put this phrase under scrutiny and its absurdity is all too evident. Benefits are only, after all, the means to living, eating, clothing, shelter, warmth. Show me a person who isn't dependent on these things. Are MPs, CEOs, bankers - physcians! - or any other wealthy individuals you care to mention somehow immune from this sort of dependency? Of course not.

    Successive governments are using the phrase 'dependency' in the sense of addiction, with all its negative connotations. If you think about it, it is actually the wealthiest in society who are more 'addicted to a culture of dependency' - a phrase governments, and especially the Coalition, like to bandy about a lot. Can it be called dependency at all when it is essential for living?

    Let's face it, if we substitute the word 'welfare' for the one of 'oxygen' - (we're all oxygen-dependent ) - we expose the phrase for its utter stupidity.

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    Anthony Turtle - About 1379 days ago

    I'm in agreement with Ms Franklin, about the author's lack of understanding, a lack of understanding that also extends to the DWP, unless I've been wrongly diagnosed.

    I have Osteoarthritis, the DWP guide says I should have been perfect within 2 years of a knee replacement, but I still have considerable pain in that knee.

    If pain was quantifiable, measurable in the way that blood pressure or temperature is, then we could prove that we hurt 24/7 at a level of 12 on a scale of 10!

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    Abi B - About 1379 days ago

    I agree with the above comment. I have EDS type three (Hypermobility type) with complex features.

    For example my right shoulder fully dislocates at least ten times every twenty four hours. This has been witnessed and noted by medical staff. And that is just one example of the many joints I dislocate or subluxate daily. (Ranging from wrists to ankles).

    I have a huge array of systemic issues ranging from recurring idiopathic anaphylaxis to serious autonomic dysfunction.

    I'd like to know how EDS Hypermobility type could ever in a million years be thought of as a ticket to benefits. How dare you. I would give it away in a heartbeat if I could.

    And my young daughter has inherited it. The thought of her living a life like mine ...yeah, woohoo, fab, maybe she'll get benefits (!!?!)

    You can't 'fake' a blood pressure of 70/45, blue sclera, and three dislocated joints.

    I'm appalled by this article. My life is often a living hell. And guess what. I *work*. I have tailored my career to being seated and part time but I was determined.

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    Anonymous - About 1379 days ago

    I have SPMS, a full time WC user - I have to take drugs to stay awake, I need assistance for most of my basic needs. You ,my dear, are spewing verbal diarrhea. Yet another abled bodied Tory making up trash as they see fit.As for the drug user and his quip about benefits? You have obviously missed the sarcasm in his comeback? You were expecting him to burst in to tears and be inconsolable? I would love to be able to have a job, any job. To be part of the world. I am housebound , even the doctor makes visits to me, my neuro via pkone. But that's okay I'm on benefits and happy , being diasabled is a perfect cover for me being lazy and work shy...

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    Tidd Kidd - About 1379 days ago

    This is pure Mansel Aylward. Is this UNUM-sponsored crap STILL doing the rounds, 20 years on? The author talks about benefits as a way of life, but this unoriginal twaddle comes courtesy of a company that was banned in several States of the USA as 'benefit deniers'.

    (By the way - the "sign in with Twitter" button doesn't work. I've done it twice and still I'm not signed in HERE.)

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    Donna Wicks - About 1379 days ago

    The comments made about Joint Hypermobility Syndrome being a ticket for potential benefits are quite ludicrous. Pain is an essential part of the diagnostic criteria of Joint Hypermobility Syndrome and is therefore is not 'JHS with associated pain'! This professionals skills and knowledge needs updating quite urgently! Most educated professionals now know (through research and evidence base) that JHS is not simplistic and does not just involve flexible joints. The term flexible means hypermobile so not sure what the person is arguing there but JHS is known to multi-systemic and often complex...especially if not diagnosed at an early stage and interventions given which help to reduce any potential for disability. Joint Hypermobility SYNDROME is a syndrome!....a whole collection of symptoms apply. JHS is argued by some to be the same at Ehlers-Danlos Syndrome -hypermobility type. Please advise the professional to have a look at this website www.hypermobility.org There he/she will see that it is far more complex than they described. Many sufferers have to put up with ignorant professionals who actually cause disability because of their lack of knowledge and willingness to engage interventions at an early enough stage. All pain conditions also involve a complex interplay of psychosocial issues which need to be addressed alongside the symptoms presented by the primary issues. As with MS you can have 2 patients with a JHS who share exactly the same symptoms but 1 of whom manages their condition positively (and may be in work...many are!) and 1 who copes poorly and exhibits what this professional calls 'sickness or illness behaviour'. This professional appears to have singled out JHS as being a diagnosis given by lazy doctors who are taking the path of least resistance so the patient can claim benefits. This is not just incorrect and disrespectful to colleagues but narrow-minded. Doctors should not be able to hide behind their reports. That flies in the face of the need for professionals and patients to work together but also suggests we should return to a culture of 'doctor knows best' and that they should not be asked to explain the rationale for their findings. It would also allow ignorant doctors to write completely inaccurate reports with no where for vulnerable and often very broken people who need a period of time to learn how to live positively and to return to paid employment where possible. The Hypermobility Syndromes Association is all about self-management....many of our volunteers go back to paid work but some of our members cannot work due to pain or fatigue or other issues relating to the complexity of their condition. At one stage I was medically retired from nursing with an original diagnosis of JHS and I find this really insulting that possibly I was 'looking for benefits'. Donna Wicks, CEO

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    Moggy PL - About 1379 days ago


    If you're anything like me you'll be climbing the walls by now with that over-used phrase so loved by the ConDems and the media - and physicians it would see,: welfare dependency. We need to challenge and expose some of these nonsense soundbites for what they are.

    Think about that expression 'welfare dependency' for a moment. When you analyse it you realize it's the most ridiculous expression on earth. I mean what is normally meant by welfare? What do you understand by it? I understand it to mean looking after the health and well-being of my fellow human beings. Dictionary definitions will say 'the health, happiness, and fortunes of a person or group' and 'statutory procedure or social effort designed to promote the basic physical and material well-being of people in need.'

    So being dependent on that or at least that concept is a good thing, isn't it? Of course, successive governments are using it to mean 'benefit dependency' but again, put this phrase under scrutiny and its absurdity is all too evident. Benefits are only, after all, the means to living, eating, clothing, shelter, warmth. Show me a person who isn't dependent on these things. Are MPs, CEOs, bankers, physicians, or any other wealthy individuals you care to mention somehow immune from this sort of dependency? Of course not.

    Successive governments are using the phrase 'dependency' in the sense of addiction, with all its negative connotations. If you think about it, it is actually the wealthiest in society who are more 'addicted to a culture of dependency' - a phrase governments, and especially the Coalition, like to bandy about a lot. Can it be called dependency at all when it is essential for living?

    Let's face it, if we substitute the word 'welfare' for the one of 'oxygen' - (we're all oxygen-dependent ) - we expose the phrase for its utter stupidity.

    Last night there was a programme on ITV3 'The Secrets Of The Workhouse'. One of Brian Cox's ancestors had a brain injury and another sort of disability but he was in the lowest category for the workhouse - Class 10 - 'the malingerers'. Yes, that's right, he wasn't believed even though he was disabled. Brian Cox was outraged at the human indignity. What Brian Cox didn't realize that this exact pernicious thinking still permeates this rotten system today. Which is why I support a Citizen's Income where work is defined in the widest possible sense: voluntary work, the arts, education, caring, bringing up children are all valued 'careers' and where everyone is valued for their contribution to society.

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    Robert Cheeseman - About 1379 days ago

    I too am a doctor and worry about the author's apparent failure to recognise that part of this 'subconscious amplification of symptoms' can be a reflection of poor mental health rather than an attempt to manipulate a system. The author should be well aware as a physician that those suffering from chronic diseases, such as hypermobility syndromes, are at greater risk of mental health problems. It appears that the extension of the author's logic then is that there is a failure of physicians to manage the mental health of patients with chronic disease making them more likely to suffer from 'subconscious amplification of symptoms', a possible outcome that the author doesn't acknowledge at any point during their piece. Better physician management of mental health issues may remediate many of issues that appear to offend the author.

    I would go further and suggest that it is not the physicians job to concern themselves with whether the welfare state is supporting a given individual or not. A physician should remain objective about optimising the health of a patient and when required provide a factual statement of a patients state of health, including mental health - no more, no less. It is the job of policy makers and social services to determine who is entitled to what. To become embroiled further risks trust not only with an individual doctor, but with the profession at large.

    That said, seeing the impact of welfare done well and comparing it to welfare gone wrong does highlight issues with the system. There is legitimate room for clinicians to inform the welfare policy debate, but that should not be based upon the ideological beliefs of a given individual or like minded group. You must remember that everyone is different and the ability to cope with identical conditions will vary from person to person. That is the nature of human existence. But while additional financial support for one person over another may not be the answer, there has to be recognition of the fact that some people will need more support and encouragement than others. The complete welfare package should be constructed - including facilitating alternative work arrangements, such as working from home.

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    Jane Young - About 1376 days ago

    Thank heaven for a sensible doctor taking the trouble to come on here and explain the necessary nuance and holistic nature of illness, health and well-being. Robert Cheeseman also rightly points out that a doctor's role, in relation to welfare, is to provide the facts. There is normally no reason why these facts cannot be seen by the patient - who might spot an error, such as a recent consultant's letter not being fully included.

    Anonymous - About 1379 days ago

    Try living with knees that randomly dislocate and bend the wrong way when walking, try moving in a chair and dislocating a hip, try draining saucepan and ending up with full thickness burns to your hands and arms due to my shoulders giving out, try dropping a kettle all over myself and having full thickness burns on my feet and ankles and try getting around on crutches when your shoulders cannot physically stay in their sockets to carry the kettle or saucepan yet are expected to carry my body weight. Try standing on a hot day or for any period of time and then autonomic dysfunction sets in and everything spins or you sweat, get so dizzy you can't stand or do anything except hope you either die or it stops soon, try not being able to eat or drink properly without feeling or being sick. Try living one day as me and then try imagining having to deal with idiots saying such ignorant things. There is a very real difference between being flexible and having Ehlers Danlos Syndrome type 3 (hypermobility type) for me I spent half my life in hospital, everything hurts because it has to work so much harder to try and stay in place, the muscles are constantly fighting the joints. It is so sad that somebody who has obviously spent so much time and money on education to become doctor is still so ignorant.

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    Anonymous - About 1379 days ago

    I commend the author for raising this debate and from what I can see Mrs Franklin's response highlights the medical bind. The description of hyper mobility in the link provided states it occurs in 10-20% of the population and that one of the two diagnostic criteria is purely subjective, whether the patient says they are in pain or not. The document also highlights associations with several other conditions, major exacerbaters of which are physiological deconditioning (e.g. PoTs). So what happens over the years is that one small group of patients who absolutely need disability support (here with the classic Ehlers Danlos) get extended into, if we follow Mrs Franklin's argument, 20% of the population who have become medicalised.

    The ferocity of Mrs Franklin's reply also provides good reason why I can see medics and others keep their heads down and just sign the forms.

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    Percy von Braun - About 1378 days ago

    Oh anon, if you think that's "Ferocious" you should see what actual anger looks like.

    There's not been a "Medicalisation" of 20% of the population - You might notice that 20% of the poulation aren't in pain, and thus aren't diagnosed with hypermobility. If the only thing that you've ever read about hypermobility syndrome is the link provided, then I can see how you'd be confused, but visiting hypermobility.org might help - The Ehlers-Danlos syndromes aren't the only painful hypermobility conditions, there's also osteogenesis imperfecta, Marfan's syndrome, Loeys-Dietz syndrome, and since EDS3 is now just called "Joint Hypermobility Syndrome" it can get a bit confusing. A lot of people who have one of the named syndromes, basically, end up with just a diagnosis of "Chronic pain on a background of joint hypermobility", and then their other symptoms (The fragile skin, cardiac trouble - POTS isn't a matter of "deconditioning", I've got a resting heart rate of 45 and spend ten hours a week in the pool, but still fint if I stand up too fast - slow digestive tract and things like that) just get treated on an as-and-when-needed basis.

    I think you need to read Ms Franklin's comment again, and think a bit harder.

    Also, feel free to have a deconstruction of the article as well - http://biteyzebra.wordpress.com/2014/09/12/a-rebuttal-to-the-physician-at-the-centre-for-policy-studies/

    Tria Hall - About 1377 days ago

    Somehow, I'm not surprised you chose to stay anonymous, with a comment like your last. At least Kaliya (who is not, by the way, a Mrs) has the integrity to put her own name to her comments.

    EDS/HMS patients don't need to be stigmatised any more than we have been for the last decade or more. I've been assaulted four times in five years because I use a wheelchair yet don't "look sick", but I have more than 80 joint dislocations a day, full and partial, and am on more pain medication than the average palliative cancer patient because of that.

    A study from 2013 came up with the result that 95% of people with EDS/HMS seen in English & Welsh rheumatology departments had gone five or more years undiagnosed or misdiagnosed before it was determined that they had EDS/HMS (I group the two together because the experts have a fair consensus that they are simply different points on a spectrum, which is more or less visible if you look at any given group of people with hypermobility and chronic pain). The trouble here is that there are a great many other symptoms that many doctors who know about the joint issues with EDS/HMS don't even think about. There's a reason most EDS patients are treated by multidisciplinary teams - and there are more of us than the published figures would suggest.

    Oh, and physiological deconditioning can cause POTS, but in EDS patients it usually isn't the main cause - that would be our unusually stretchy blood vessels, due to the collagen issue involved. So passive-aggressively suggesting we're all lazy or deconditioned - not the case, since muscle strength is a greater part of reducing dislocations in EDS/HMS patients and we usually undergo a great deal of physio and hydrotherapy if we're getting proper treatment and help at all - is a laughably clueless thing to come out with. Talk to a cardiologist who knows about EDS and dysautonomia - preferably one who works in a hospital with an EDS specialist, they'll be more knowledgeable in the specific area - and they would tell you that in a moment. Many people with connective-tissue disorders deteriorate drastically from a point of actually having been fitter and more active than the norm. It's harsh, but unfortunate, and a fact of our biology.

    Please, if you're going to attack a group of people like that, do think about what you're saying and do your research properly, first.

    Anonymous - About 1379 days ago

    I am thoroughly disgusted that a well educated person (a doctor no less) can be so monumentally stupid!!
    His assertions that being sick is a "career choice" purely for the disability benefits is outstandingly scurrilous.
    I am also a well educated person and yet I LOST my career due to ill health. Something I have never truly come to terms with, as my career was everything to me (never married, never had children).
    I now have the specter of the work capability assessment and Atos hanging over every single day.
    This person obviously hasn't the faintest idea the hatred and harm his opinions may incite

    I leave it there as I could rant for hours on this topic. It strikes very close to home and I am apoplectic that someone who should know better, is so damn idiotic and careless.

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    Anonymous - About 1379 days ago

    I am thoroughly disgusted that a well educated person (a doctor no less) can be so monumentally stupid!!
    The assertions that being sick is a "career choice" purely for the disability benefits is outstandingly scurrilous.
    I am also a well educated person and yet I LOST my career due to ill health. Something I have never truly come to terms with, as my career was everything to me (never married, never had children).
    I now have the specter of the work capability assessment and Atos hanging over every single day.
    This person obviously hasn't the faintest idea the hatred and harm his opinions may incite

    I leave it there as I could rant for hours on this topic. It strikes very close to home and I am apoplectic that someone who should know better, is so damn idiotic and careless.

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    Jayne Linney - About 1378 days ago

    There is a reason GPs are named such they are General Practitioners; many who see a patient for 5 minutes and prescribe antibiotics for everything!

    Of course the above is demeaning for many good GPs, just as the article above demeans the majority of disabled people' particularly those of us with 'Invisible' disabilities.

    Given the level of information I receive daily regarding such invisible disabilities, I doubt GPs have the time, even where they have the inclination to read all reports; however sweeping comments such as the author uses demonstrate that ignorance

    It has long been my thinking that Policy Makers would gain far better insight into disability issues if they engaged with the wider disabled community; and selected their 'experts' more appropriately. This article demonstrates precisely why.

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    greg wood - About 1378 days ago

    Not impressed that this author is afraid to identify himself. What sort of physician is he - or she? These ideas are quite old now: about a decade old in fact, and the debate has moved on.

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    B Price - About 1378 days ago

    There is a very simple solution to this. Give every individual the basic amount of money to live on (in the manner of child benefit going to all children). Then the fortunate well people can all choose whether to subsist or live a decent life whilst the ill can at least live stigma free.

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    Michael Banks - About 1378 days ago

    Excellent article, I couldn't agree more.

    https://www.youtube.com/watch?v=PY3_8SrCp-M

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    Franks Dad - About 1377 days ago

    The trouble is, this is so unscientific. Any patient with any illness can be written off as being a malingerer. This article does nothing to enable practitioners to differentiate between fraudulent and genuine cases. As far as the recommendations - assessments could include advice regarding what level of regularity and strenuousness of work related activity the claimant could manage.

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    Chris McCabe - About 1376 days ago

    It's alarming that the writer is a physician, as the lack of understanding of chronic conditions skews the whole article into 'Benefits Street' territory, & is entirely unhelpful to a doctor/patient relationship. Even those of us who are fairly fit (eg, I can walk pretty well >90% of the time) are not wanted by employers, who can pick & choose from fit people, nor by the shameful businesses who exploit 'Workfare', free labour for them which destroys paid work. Most of us with some level of fitness are doing voluntary work, where we aren't penalised for days when we can't work, & can re-schedule when necessary. I've always worked, & now that my spine has started to degenerate, it's extremely difficult to access out of work benefits, since private firms like Atos have a contract to deny disability.

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    Anonymous - About 1376 days ago

    Anonymous anecdotes by anyone do not make good politics.
    The examples cited,unreferenced and told like stories to support the political point of this website, are meaningless.no numbers,dates, regions,no real information,just prejudiced opinion.

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    Anonymous - About 1376 days ago

    This publication is the authors personal opinion,
    and rather a derogatory one at that. In 2014 many
    many health professionals get slammed down,
    then complain that their findings are treated unfairly etc. Is it a wonder?? As a parent of 2 children with EDS type 3, pots etc etc, it tires me
    that daily these opinions are published with little
    usually nothing too substantiate the opinion! It's hard enough too have too listen too the educated
    professionals speak the fact less, drivel that leaves
    you breathless! The author is wrong on so many
    levels and leaves me more worried that the situation couldn't possibly improve, regarding opinions from the dark ages but rather it's being
    pushed further down!

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    Anonymous - About 1376 days ago

    Ehlers Danlos Syndrome is a collagen disorder resulting in joint, hollow and solid organ instability. It is because of the widespread nature of collagen as the ubiquitous structural protein of the body that it had such widespread effects. Slow gut syndrome, high myopia, retinal detachments and subsequent blindness, joint instability, premature osteoarthritis due to abnormal load bearing within joints, wound dehiscence, hernias of various kinds - particularly incisional ones, premature rupture of the membranes in pregnancy, solid organ rupture, spontaneous pneumothorax (punctured lung), death. Its not hard to work out what the possible consequences of abnormal collagen synthesis if you stop and THINK about it.

    Don't forget your high school physics either - for every action, there is an equal and opposite reaction. When you take a step, when you push a button, when you hold a pen, the force applied to the surface transmits and equal force back in the opposite direction towards the joint. When the joint isn't supported by normal ligament and tendon structures, the joint is unstable leading to more rapid wear and tear, joint dislocation and potential for nerve damage (neuropraxis).

    POTS is the consequence of increased compliance of the vasculature in response to blood pressure. Most people have vessels that have some 'give' in them, a little like a corrugated hoover hose, that with time becomes 'hardened', a bit like a load drain pipe. With EDS, the abnormal collagen in the blood vessels means there's a greater degree of vascular compliance, more like a rubber balloon. This lack of rigidity in the vessels means they struggle to maintain a normal level of blood pressure, and the normal orthostatic response that helps maintain normal blood pressure when moving from sitting to standing is impaired. These vascular anomalies are what predispose some EDS sufferers to the development of aneurysms and the associated risk of death.

    Before another medical professional tries to espouse a certain point of view and support that view with a particular medical condition, i suggest that they do their homework about this little known but nevertheless DISABLING condition. I hasten to add that while not all EDS sufferers are disabled, it is erroneous to assume that all patients with EDS are disabled/not disabled to equivalent degrees. Not every disability is visible.

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    Bev Rawsthorn - About 1376 days ago

    This Doctor is so ignorant he is dangerous!

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    Jane Young - About 1376 days ago

    This is a very troubling article, especially for genuinely disabled or sick individuals whose conditions are poorly understood or whose condition presents in a way that is rare for people with their condition. In addition, in his or her analysis of socio-geographical factors the author fails to acknowledge the impact of gruelling life experience and/or hard manual labour, that affect people in their 50's and early 60's in some northern areas. In this respect, and others, the article displays bias.

    I am also very troubled by the author's singling out of hypermobility in the way she or he has. I can do no better in thus respect than to commend Kaliya Franklin's comment to this same article. Incidentally, I can see no "ferocity" in Kaliya's comment; she politely disagrees with the article and refers to accepted advice on hypermobility and connective tissue disorders to support her (well informed) view.

    The author appears to have a negative view of human nature and human frailty, which itself is disturbing in a "physician", whose clinical experience should have informed him of the dangers of taking an overly simplistic view of people's lives and motivations. For example, if mobility support is not provided to all those who need it, how are they to make the sometimes difficult journey towards productive activity? Or parent their children? Or support their elderly relatives? And surely an inability to get around will further decrease their chances of maintaining good mental health?

    This article is troubling on many levels and is particularly controversial - I would go so far as to say irresponsible - at a time when disabled people and people with long term health conditions are experiencing real hardship due to recent welfare reforms, particularly so-called "assessments", the reports from which often bear no relation to the medical issues affecting the person assessed.

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    Rob Parsons - About 1375 days ago

    I have rarely read such an ill informed article. If I lived in the northwest, I think I would be checking very carefully who my physician is in order to avoid being treated by this person.

    Does the Centre for Policy Studies not encourage people to consider evidence when coming to conclusions?

    Can I suggest the writer of this article tries to acquire hypermobility. Then they can spend the next thirty years considering the wisdom of their lifestyle choice.

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    Gen William Taggart - About 1374 days ago

    yet more cods-wallop to come out of the Unum style bastardisation of the biopsychosocial model.

    What makes it worse is it's not even original. It's the same old politically/financially fueled diatribe, that has been reeled out over the past few years (almost word, with a certain Prof' who is also on the Unum payroll in Swansea)

    The only really disturbing thing here is that anybody would even consider this unscientific social engineering project to be even in the smallest part valid.

    Take your nudge unit garbage and shove it where the sun don't shine.

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    Anonymous - About 1008 days ago

    'Illness as a career choice' ? You cannot be serious. Are you sick, suffering from delusions? Or just believe what you read/were told?

    You: 'In reality the relationship between errors and complaints is surprisingly shallow.'
    I dont believe that is true (or REALITY) = please provide evidence for your staement.

    You: '1. Doctors reports should be anonymised and made confidential. The current forms are better than the previous ones, but need support from non-assessment service doctors and this will work best if those doctors can be open and frank.'
    This must be a joke/satire! I can't believe you or ANYONE would believe/write this. Actually re-reading it I don't understand what you mean: not clear at all. Of course our medical info should NEVER be given to ANY non-doctors (clerks) or doctors of any kind not involved in our treatment, not known to or chosen by us. Our treating doctors should (if really required) state what funding we need - not WHY or WHAT FOR because those are OUR personal and very private medical secrets.

    I expect (and hope) you know all this and are only acting as devil's advocate?

    You: 'The Government must encourage the full range of mental, physical and social activities.'
    Yes: and it must PAY for them and must understand and cater for (treat) ALL disabilities/illnesses equally. Obviously only WALKING is free of charge...

    3. For conditions which can be ameliorated by the action of the individual, greater emphasis should be placed on determining the right balance between disability payments and programs that emphasise greater personal responsibility for recuperation.

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