Incidence of chronic, unexplained conditions in FM

[Fay8]

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Hi all,

I was wondering how often you encounter "interesting" cases where patients present with unexplained, chronic health problems? I'm interested in studying CFS/FM/chronic lyme, and this is one of the reasons I want to go into primary care medicine.

(I understand this is a topic which makes people roll their eyes. Too many people think they have it. There is a stigma of mental illness and poor lifestyle choices-to put it nicely- attached to these diseases)

As health care providers, what do you do when you encounter "normal" people that should be healthy, are sane, but continue to have debilitating symptoms?

Thanks for your input

 

[iswitched]

As health care providers, what do you do when you encounter "normal" people that should be healthy, are sane, but continue to have debilitating symptoms?

Symptoms are representative of a condition. The condition is either "normal" or "abnormal." When a social net or secondary gain is involved, in my experience, the patient is more likely to categorize his/herself as "abnormal." How much debilitating CFS/FM do you think you find in tribes in the Amazon River Basin? Nada.

If you get into medical school and pay attention, or otherwise do some research, you'll find an abundance of research on the subject to which you speak. To summarize my understanding of the same, both stupid patients and stupid physicians are wrong. There is clearly a psychological/mental/nervous system pathology involved. Patients generally are not "making things up." Thus the patient is not "crazy" but it is still largely "in their head" (or nervous system).

What do I do with such a patient? Generally a history, maybe a screen for rheumatologic disease. 90+% of the time there are significant psych issues. I refer to psychologist and provide education and re-assurance. I encourage full-time work, exercise, proper diet, proper sleep. No excuses for anything less. Anything less is guaranteed to have a worse outcome I would argue. I don't enable endless workups/referrals that in my experience only further substantiates the existence of a "yet to be correctly diagnosed problem" (further navel-pondering behavior).

Notably people with other senseless conditions such as multiple sclerosis typically/frequently learn to live with their frequently unpredictable disease. FM/CFS patients on the other hand are frequently on a life-long crusade for more answers and public education instead of just accepting uncertainty (which is telling).