I ask because from my experience and my experience with family and friends is that Doctors go to the "it's all in your head card way too quick and way too often.

This may just be a sign of a bad doctor or a big ego but it got me to thinking if a part of the education of MD's involves looking for patients that have imagined symptoms. No doubt some patients will have imagined symptoms but that % would be very low.

No doubt some patients will have imagined symptoms but that % would be very low.
Clearly you haven't yet had the pleasure of a long-term working relationship with a "dx'd fibromyalgia" pt. At best they are confused, but more likely to be an annoying splatter of axis II goodness.
When a "disease" does not have any clinical markers and lacks physiological evidence, it is psychiatric. I'm all for getting these people the help they need, but not under the guise of a medical problem.

I ask because from my experience and my experience with family and friends is that Doctors go to the "it's all in your head card way too quick and way too often.

This may just be a sign of a bad doctor or a big ego but it got me to thinking if a part of the education of MD's involves looking for patients that have imagined symptoms. No doubt some patients will have imagined symptoms but that % would be very low.

Once you start seeing patients as a doctor, you will quickly realize how green your post sounds. Medicine is evidence based. You have to look for OBJECTIVE evidence. You cannot just rely on subjective evidence.

If you give every Pt. who comes to your clinic complaining of 10/10 pain in their lower back (which is VERY common) Percocets, Lortabs, and Morphine...then good luck.:rolleyes:

Maybe (s)he wants to work in pain medicine...
COUNT ME OUT!

Clearly you haven't yet had the pleasure of a long-term working relationship with a "dx'd fibromyalgia" pt. At best they are confused, but more likely to be an annoying splatter of axis II goodness.
When a "disease" does not have any clinical markers and lacks physiological evidence, it is psychiatric. I'm all for getting these people the help they need, but not under the guise of a medical problem.

ok maybe I should have not qualified it as very low.

But the line is quite long with people with endocrine and neurological illness's that have been told by Doctors that what is wrong with them is psychiatric when in reality they have a physical illness.

I get your point but at the same time, the thyroid disorders I think you're alluding to are managed according to lab values--tsh, t3, t4 etc. If the labs show a bat**** low tsh and you walk out of an endocrinologist's office still convinced your thyroid is the reason you're fat...well you're gonna have to take that up with a naturopath.

My experiences w/fibromyalgia made a strong impression that once dx'd, it's blamed for every problem under the sun--which isn't necessarily the patient's fault. Hence why slapping a name on a set of S&S should mandate distinctly outlined signs and symptoms.

I get your point but at the same time, the thyroid disorders I think you're alluding to are managed according to lab values--tsh, t3, t4 etc. If the labs show a bat**** low tsh and you walk out of an endocrinologist's office still convinced your thyroid is the reason you're fat...well you're gonna have to take that up with a naturopath.

My experiences w/fibromyalgia made a strong impression that once dx'd, it's blamed for every problem under the sun--which isn't necessarily the patient's fault. Hence why slapping a name on a set of S&S should mandate distinctly outlined signs and symptoms.

well i wasn't alluding to thryoid per se, rather all endocrine disorders. Talk to anyone who has been diagnosed hypopit and chances are they had been told by previous Dr's that what was ailing them was psychiatric. The endocrine system is complex and not everything is cut and dry as thyroid lab values. You can have a normal thyroid function and have a pit tumor causing growth hormone deficiency.

You can have a normal thyroid function and have a pit tumor causing growth hormone deficiency.

Which again, can be evidenced through imaging, f(x) tests, etc.

I'm not sure what your point is, yes doctors are trained to rule out psychiatric illnesses, but the way they are ruled out is through a variety of tests. This is the scientific method. . .I doubt any patient has ever been dismissed without even going through the motions of differential diagnosis (unless their insurance wouldn't cover a visit :D). Of course presenting to a psychiatrist might yield a different answer than presenting to an IM doctor; thus why most undifferentiated problems are first brought to PCPs and then referred to specialists...

dammit the server at my post.

I think what's going on here is confusion as to the order of r/o--someone can correct me if I'm wrong, but I think a psychiatric diagnosis is one of the LAST options when NO evidence supporting a medical problem can be furnished. Innocent until proven guilty, if you will :)

I ask because from my experience and my experience with family and friends is that Doctors go to the "it's all in your head card way too quick and way too often.

This may just be a sign of a bad doctor or a big ego but it got me to thinking if a part of the education of MD's involves looking for patients that have imagined symptoms. No doubt some patients will have imagined symptoms but that % would be very low.

Alex you are describing the subset of patients who are probably misdiagnosed the most, endocrine patients, because they usually manifest with vague symptoms and don't usually produce pronounced physical exam abnormalities. So in this population, you are probably right, there is quite a bit of underdiagnosis. But for every truly hyperthyroid graves patient complaining of anxiety and insomnia, there are probably 10 garden variety anxiety patients. So often doctors dismiss these patients early on just because they seemed like the last 10.

The psychiatric burden is pretty high in PCP's offices. But you need to keep a healthy suspicion otherwise you will miss people with real disease.

Just this week I have taken care of someone who has had about 100,000 dollars or more worth of care pretty much because they didn't want to eat and gain weight, and were devising all sorts of excuses (abd pain, throat pain, nausea, mouth sores, etc) which were triggering all sorts of tests that were unnecessary. Basically the patient didn't want to eat.
The patient didn't let us know that however, until all this expensive testing was done. Perhaps they liked the attention as well.

It's unfortunate, but when doctors have lots of patients crying wolf, they don't hear the real ones crying sometimes.