Physician’s Fibromyalgia Folley

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(Author’s term for Boland’s accusation which he related to psychosomatic disorders in general and psychogenic rheumatism, which is essentially his old name for what is now known as fibromyalgia.)

Boland wrote: “Physicians are not so familiar, however, with the fact that disabilities of the locomotor system frequently result from psychic causes. Too often functional musculoskeletal symptoms are mislabeled as arthritis or some other organic disease. By failing to recognize the true nature of the complaints and by treating the patient for arthritis the physician fosters rather than alleviates the disability. Psychogenic rheumatism may be defined as the musculoskeletal expression of functional disorders, tension states, or psychoneurosis. It implies that such symptoms as pain, aching, stiffness, muscular fatigue, subjective sense of swelling, or limitation of motion may be caused, intensified, or perpetuated by mental influences.” (Page, 196, italics added for emphasis.)

The physician’s fibromyalgia folly is the tendency for certain physicians to fail to recognize psychosomatic illness along with a tendency to take the symptoms at face value and to attempt interpret them as being “organic” in nature. Truth be told, the same pattern of thinking is found in many members of the general public.

The author has observed what is in his estimation are a number of trends amongst those that are subject to this folly:

  • The doctor feels flooded and overwhelmed by the sheer number of symptoms that often occur in these patients.
  • The doctor lacks the training and skills to delve deep into the underlying psychological issues.
  • The doctor has fallen for the latest fad explanation for fibromyalgia blaming it on some “evil” toxin or germ. (There have been many.)
  • The doctor is quietly upset that there is no simple way to diagnose and treat the patient, especially using the standard physical examination and history taking skills he or she was taught in medical school.
  • The doctor is frustrated by the many challenges associated with caring for severe fibromyalgia patients including but not limited to their generally poor attendance. (“No shows” are an ongoing problem which is even a bigger problem for psychologically-minded doctors who try to provide an in-depth approach such as counselling or psychotherapy. Such doctors may even set aside an hour for sessions, only to find the patient missed the appointment due to some combination of pain, confusion over dates or exhaustion due to a flair.)

(For further perspective see the entry Anti-psychological Attitude.)