I have a challenging job, to say the least. I am confronted daily with problems that I will not–cannot–solve in my role as a PCP. I can see the all of humanity’s ills, all of the failures both small and large. Blame capitalism, human nature, illiteracy, poverty, governmental failure, lack of motivation, poor nutrition, abuse, trans fats, t.v. It’s all there in my clinic waiting room. I can take it on (possibly not all at once, but I can try!). But one thing really makes me want to hide in my office. What might that be? “Chief complaint: FIbromyalgia.” Now, I’m not trying to blame the patients for their disease. I do believe that fibromyalgia is a real syndrome that affects how the body processes pain. It has far reaching–and at times disabling–effects. It’s just that Fibromyalgia (and it’s cousin, Low Back Pain) are chronic and basically incurable. Patients that are exceptionally motivated can exercise, stretch and medicate themselves into relatively pain-free functionality (often at a considerable personal expense due to massage, chiropractors, herbal supplements, etc). However, note my use of the word exceptional. By definition, most people are not exceptional. The majority–if not all–of my fibromyalgia patients are depressed, which severely compromises their motivation. Most of them have chaotic home lives that involve caretaking of family members at the expense of their own needs. Many of them have zero disposable income when their expenses are paid. Some of them have addictions that interfere with their personal growth, their judgment and their savings accounts. I know all of this. I feel for my patients, and because of this I try not to be judgmental about their illness. I like to think that I avoid talking down to people, and I don’t believe that anyone should be shamed about their conditions, including psychosocial issues. I have to confess, though, there are times that I want to slam the chart shut and yell at the patients. I envision myself saying non-therapeutic things, like “Look, you’re never going to get better if you sit on the couch and mope all day.” Or, “Can you just go to physical therapy already?”. On a bad day, my internal dialog gets worse. “Stop crying,” I want to say to people, “Do you know how many people have already cried to me today?” Or: “Stop asking me for more medication to fix this! I already told you, exercise, sleep, gentle stretching and anti-depressants are the best treatments! Why won’t you do that? Why? WHY?” I don’t say these things, and I try to keep my frustration off of my face. That’s probably the reason that the patients keep coming back to me. Other providers are not as circumspect. Repeat these visits ad nauseum, and you can see why most providers roll their eyes when they hear “fibromyalgia.” I have no answers about how to fix fibromyalgia. If I did, I could singlehandedly improve about 1000 people’s lives in my community alone.
My personal challenge: fibromyalgia November 22, 2008