The Art of Good History Taking in Fibromyalgia

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The art of medical assessments calls for trying to get past as many of these barriers as possible and in a timely manner. This is not easy and it requires a certain skill set.

If the patient becomes engaged, they will generally start volunteering pertinent facts. This often comment out in quick paced emotionally charged monologues. The doctor often needs to slow the patient down in order to avoid getting flooded with too much information. Sometimes this unfolds as what has been called “injustice collecting” whereby the patient volunteers describes a disturbing list of the terrible things that have been done to them.

Sometimes the patient opens the door to the doctor by giving a partial answer to a question that serves as an incomplete clue to their issues. The clinician needs to walk through the door by asking probing thoughtful follow-up questions. There is an art to this. Some clinicians have great intuition and a good sense of what needs to be asked. This skill is hard to teach.

Freud was a master of this as is apparent in his book, Studies in Hysteria. (As it turns out, at least one of the patients almost certainly had fibromyalgia. She was in chronic pain and also had hysteria. For details see the entry Analysis of Freud’s Case of Elisabeth von R (Ilona Weiss).)

Unfortunately, medical history taking in fibromyalgia is often somewhat “robotic” and rushed. A typically fibromyalgia assessment of a complex patient can easily take 4 sessions of an hour. Many busy family doctors cannot afford to make this time commitment without throwing off their schedule. Some can. Often psychiatrists and psychologists and pain specialists can organize themselves for such in-depth assessments.