Objective:

The aim of this study was to determine the degree of educational exposure to and clinical experience in delivering a diagnosis of functional neurological disorder (FND).

Background:

The prevalence of FND within the United States is estimated to be 250,000-300,000 with healthcare costs totaling over $1 billion annually. FND is important to diagnose accurately and timely as it is a treatable condition with otherwise heavy burden in terms of disability, and negative impact on quality of life, career and family.

Design/Methods:

An anonymous 38-question survey constructed through Qualtrics, inquiring about training in and delivering a diagnosis of FND was emailed to neurology faculty at Mayo Clinic Minnesota, Arizona, and Florida. 

Results:

A total of 235 neurology providers were surveyed and 76 (32%) completed the survey. Of these, only 22% (n=17) reported receiving structured education on how to deliver a diagnosis of FND during training, mostly (88%, n=15 of 17) as didactic lectures. Unstructured training reported by 93% (n=53) included watching another provider deliver the diagnosis of FND. In clinical practice, 97% (n=72) had delivered a diagnosis of FND and 55% (n=40) reported feeling apprehensive when doing so, with 97% (n=67) having experienced a negative patient reaction. The most common reasons for concern included worrying the patient may be dissatisfied with their care (88%, n=35) or may be disappointed in their clinician (63%, n=25), about the potential of receiving patient complaints (63%, n=25), or offending the patient (58%, n=23).

Conclusions:

While the vast majority of neurology providers in this survey have delivered the diagnosis of FND in clinical practice, a minority have received formal instruction on how to do so during their neurology training. Most had experienced a negative patient response, and more than half felt apprehensive giving this diagnosis. Patient dissatisfaction is the most common reason for apprehension regarding delivering this diagnosis.