Reader response: Functional neurologic disorders: Bringing the informal and hidden curriculum to light
Andrea M.Chau, Medical Student, University of Colorado School of Medicine
Submitted August 04, 2020
I read the editorial by Strom1 with interest. From my perspective as a medical student, the hidden curriculum regarding functional neurologic disorders (FND), discussed by Dr. Strom begins as early as the first year of medical school.
When I described my research in non-epileptic seizures (NES) to a peer, he asked me if NES was similar to “pseudoseizures,” which he encountered in the emergency department and described as not real. Although the term “pseudoseizure” is pejorative2 and antiquated, the term and its negative connotations extend through the current generation of physicians-in-training. The pervasiveness of such language supports the presence of a hidden curriculum that drives stigma associated with FND.
On separate occasions, I noted my work with the NES population to a physician and third-year medical student. When I mentioned stigma associated with NES, both were reticent to discuss it further. Later, the physician admitted his limited understanding of NES. Such lack of knowledge is common and instigates negative healthcare interactions that can lead to emotional and physical repercussions and avoidance of future care in patients with NES.3
Remedying the stigma associated with FND will require interventions that target and eliminate drivers of stigma, alter norms, and change policies.4 It is time to replace the hidden curriculum.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Strom LA. Functional neurologic disorders: Bringing the informal and hidden curriculum to light. Neurol Clin Pract 2019 Dec.
Gates JR. Nonepileptic Seizures: Classification, Coexistence with Epilepsy, Diagnosis, Therapeutic Approaches, and Consensus. Epilepsy Behav 2002;3:28–33.
Robson C, Lian OS. " Blaming, shaming, humiliation": Stigmatising medical interactions among people with non-epileptic seizures. Wellcome Open Res 2017;2:55.
Stangl AL, Earnshaw VA, Logie CH, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019;17:31.
I read the editorial by Strom1 with interest. From my perspective as a medical student, the hidden curriculum regarding functional neurologic disorders (FND), discussed by Dr. Strom begins as early as the first year of medical school.
When I described my research in non-epileptic seizures (NES) to a peer, he asked me if NES was similar to “pseudoseizures,” which he encountered in the emergency department and described as not real. Although the term “pseudoseizure” is pejorative2 and antiquated, the term and its negative connotations extend through the current generation of physicians-in-training. The pervasiveness of such language supports the presence of a hidden curriculum that drives stigma associated with FND.
On separate occasions, I noted my work with the NES population to a physician and third-year medical student. When I mentioned stigma associated with NES, both were reticent to discuss it further. Later, the physician admitted his limited understanding of NES. Such lack of knowledge is common and instigates negative healthcare interactions that can lead to emotional and physical repercussions and avoidance of future care in patients with NES.3
Remedying the stigma associated with FND will require interventions that target and eliminate drivers of stigma, alter norms, and change policies.4 It is time to replace the hidden curriculum.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References