Questions and answers about the operation of Outpatient Clinic for Functional Disorders

What are functional disorders, what causes them, and why is it so difficult to recover from them?

Functional disorders include a wide range of complex and varying medical conditions. Our scientific understanding as to their underlying causes is constantly developing and the outpatient clinic’s experts actively follow the current research. Many causes are known, such as hereditary risk factors, various stress and environmental factors, viral infections, and other illnesses. Most commonly, a functional symptom or disorder is due to a combination of several factors.

Often the causes cannot be completely eliminated and even avoidance of trigger mechanisms has not yielded convincing results. In current knowledge, the most viable model of operation is to seek effective methods to improve symptoms. Recovery often requires that the cycle of inconclusive examinations is broken and the focus is shifted towards improvement in symptoms instead of trying to find a cause. The outpatient clinic has both research and practical knowledge of numerous patients who have recovered from functional disorders.

Do professionals at the outpatient clinic believe my symptoms are real, even if they aren’t necessarily visible?

The outpatient clinic’s premise is that the symptoms are real. We listen to our patients carefully. Even if no exact cause for the symptoms could be identified, the symptoms can be controlled or reduced. Very often, no exact cause can be identified with the medical examination methods currently available. Instead of looking for a cause, it is more productive, after careful medical examinations, to focus on improvement in symptoms, in the same way that chronic pain is treated.

Who are the clinic’s professionals?

The outpatient clinic’s staff consists of a chief physician, registered nurse, psychologist and a part-time social worker. Additionally, HUS's steering group for functional disorders, which has met in HUS since early 2018, supports the outpatient clinic's operation. Experts from various medical specialties take part in the outpatient clinic’s weekly co-operative meeting where the treatment and rehabilitation of patients is planned individually.

What are the clinical practice guidelines the outpatient clinic follows?

The Finnish Medical Society Duodecim has received appropriation from the Ministry of Social Affairs and Health to clarify treatment of chronic fatigue syndrome. Work on these clinical guidelines will begin in fall 2019 and will probably continue for several months.

While waiting for Finnish clinical practice guidelines, the outpatient clinic uses foreign clinical practice guidelines and existing research knowledge about treatment effectiveness in functional disorders.

Is the outpatient clinic committed to the so-called Danish model?

Our outpatient clinic is in no way affiliated with the The Research Clinic for Functional Disorders in Denmark. Our staff is aware of the work of the Danish clinic for functional disorders and has studied the research carried out there. Equally, we follow research carried out at other research clinics and keep a curious and open mind towards the developing treatment models.

Does the outpatient clinic provide oxygen therapy, immunoglobulin therapy, or rituximab for treatment of chronic fatigue syndrome?

HUS is a publicly funded operator and our operation is based on therapies that have been proven effective. We can provide experimental therapies only in a clinical trial. We actively follow the latest news in research and utilize new information in the treatment of our patients. Decisions regarding rare and new treatment models are made by medical specialists in their weekly meetings.

Does the outpatient clinic provide medical statements for disability pension?

Functional disorders are a challenging area in terms of social insurance in Finland. The outpatient clinic initiates research and works actively with Kela attempting to ensure that patients receive the social benefits that they are rightly due. Because the outpatient clinic’s resources are minimal, we cannot provide assessment of work ability. However, the treatment and rehabilitation plans created at the outpatient clinic provide important information towards any later work ability assessment that takes place in occupational health care or at an occupational health care provider.

Can I also receive treatment in my home municipality?

The mission of the outpatient clinic is to increase awareness of functional disorders and develop their treatment in the entire country. We are assembling a nationwide network of operators that can learn more and develop treatment for these disorders together. As trainers, we participate in events organized by other operators.

Which treatment and rehabilitation methods does the clinic recommend?

The Outpatient Clinic for Functional Disorders has five clinical pathways in use. 

  • ​ Psychoeducation, which provides information about functional disorders and how to cope with them. Our entire multi-professional team has been trained to give out information and to support the rehabilitee.
  •  We carry out our own six-appointment group intervention therapy held by a psychologist, a social worker and a psychophysical physiotherapist.
  • The outpatient clinic refers patients to Kela's rehabilitation trial for functional disorders.
  •  Online therapy for functional disorders will begin in May 2020.
  •  We also issue certificates for Kela’s medical rehabilitation for persons with severe disabilities and other Kela's therapies.

 

Does the clinic recommend Maria Nordin’s Free to Heal (Eroon oireista) course for its patients?

The course is not included in our work or recommendations, and our experts have not mentioned it in any interviews they have given. HUS cannot recommend a self-care program that does not yet have scientific proof of its effectiveness.

However, the DNRS method (dynamic neural retraining system) has been recently presented at a renowned Canadian medical congress, and it is currently studied by researchers with high-quality methods at McMaster University in Canada, among others. Scientific evidence has been available since last November. We follow these studies with great interest.

 ​