How can I effectively communicate the diagnosis of FND to patients to ensure understanding and adherence to management plans?

Effectively communicating the diagnosis of functional neurological disorder (FND) to patients involves several key steps to ensure understanding and adherence to management plans.

• Provide a clear, positive explanation of the diagnosis: Explain that FND is a "rule-in" diagnosis based on positive physical signs, confirming that symptoms are genuine, involuntary, common, and potentially reversible with treatment. Emphasise that FND is a problem with how the brain and nervous system send and receive signals, rather than damage or a disease process, often described as a "software" rather than "hardware" problem of the nervous system. This helps validate the patient's experience and reduces stigma or misunderstanding about the condition ¹.
• Use understandable, relatable language and examples: Tailor explanations to the patient's symptoms, for example, describing how the brain may have a "faulty movement programme" or how symptoms fluctuate and may worsen with stress. Use demonstrations of variability or improvement with attentional redirection to illustrate the mechanism and potential reversibility of symptoms, such as showing how a limb may briefly return to normal during examination ¹.
• Check patient understanding and address concerns: Actively check the patient's comprehension of the diagnosis, explore their concerns, expectations, and motivation for change. Avoid attributing symptoms solely to anxiety or stress, as this oversimplifies FND and may invalidate the patient's experience ¹.
• Provide information about support and resources: Offer access to reputable patient-led charities and resources such as FND Guide (neurosymptoms.org), FND Action (fndaction.org.uk), FND Hope UK (fndhope.org), and the MyFND app (myfnd.co.uk) which provide educational materials, self-management techniques, and peer support ¹.
• Explain the rationale for individualized multidisciplinary management: Discuss treatment options including physiotherapy, occupational therapy, speech and language therapy, and psychological support such as cognitive behavioural therapy, tailored to the patient's needs and wishes. Emphasise that treatment focuses on improving function rather than solely reducing symptoms ¹.
• Communicate openly and consistently: Maintain clear, transparent communication with the patient, their family, and other healthcare providers to build trust and encourage engagement with treatment plans. This approach supports better outcomes and reduces the risk of inappropriate investigations or treatments ¹.