It’s ironic to think that medicine has come such a long way since the time of Hippocrates (the father of medicine). Medical knowledge has grown exponentially over the past 100 years. However , we are just at the dawn of accepting and understanding a condition that has been with us throughout the ages , but has been given little recognition let alone validation by the medical community. I have been treating patients with fibromyalgia for the past 20 years. I first became acquainted with this condition in 1990 when I was in the first year of my rheumatology fellowship at Dartmouth .I had just finished a three year internship and residency training in internal medicine. During those tough three years I was exposed to a vast array of medical conditions ranging from minor ailments that were addressed in the outpatient clinic setting to complex medical diseases--many which needed management in the intensive care unit. Would you believe that after four years of medical school and three years of post-graduate training in internal medicine I never heard of fibromyalgia!
In my opinion, this exemplifies why physicians know very little about fibromyalgia--there has been little opportunity regarding formal training of this condition in medical school and post graduate medical training programs. I’ve often wondered how this apparently prevalent condition has gone through the cracks for so many years. I do have a theory about this phenomenon. First of all, medical students are not educated on fibromyalgia because historically there have been few experts in this field--as you can already see we’re not off to a good start where after four years of medical school the knowledge that a young doctor possess about fibromyalgia is minimal at best! Then comes internship and residency. For young physicians who choose to go into fields of medicine other than internal medicine and family practice, the potential for these doctors to gain practical knowledge regarding fibromyalgia diminishes with each passing year. For those doctors that take the plunge into internal medicine and family practice it’s extremely unlikely that they’ll ever see a fibromyalgia patient in the hospital--unless they are involved with a patient that is being worked up in the ER or briefly admitted to the medical unit for unexplained pain. These patients are quickly ruled in or ruled out for more serious acute medical conditions. When it is determined that these patients are not in acute medical danger they are often classified as having fibromyalgia as they are shown out the door of the hospital. Discharge instructions will tell these patients to follow-up with their primary care providers in a week or so. Unfortunately, the primary care providers don’t know what to do with these patients. Many are branded as hypochondriacs and malingerers. If these patients are lucky they may get a referral to see a rheumatologist, but they may have to wait a few months until an appointment becomes available. Many rheumatologists will not accept patients with the diagnosis of fibromyalgia. At this point, it’s not looking very good for patients with fibromyalgia given this scenario. This is the reality of the situation. If you’ve been keeping track of the years, you’re looking at a well-intended physician who after four years of medical school and three years of internship and residency training (seven years in total) may have virtually no knowledge let alone experience in treating fibromyalgia--that’s a scary thought! And by the way, after a doctor completes the hospital training program, it’s quite possible that one of the first few patients that walks into the physician’s office will have fibromyalgia--the guy who was sent home from the ER last week! And so begins the beginning of a long relationship of mutual frustration between the physician and patient. I really do believe that this represents the life-cycle of fibromyalgia and the medical community.
By now, you’re probably wondering if there is anyone out there that can help people (you) with this condition. The answer is “yes”--but it won’t be easy. This is my reason for writing this book. Physicians need to be educated about this condition. Patients with fibromyalgia need to be embraced. The present life-cycle of fibromyalgia needs to be broken. I’m sure that I’m not the only Rheumatologist or medical physician that has been treating fibromyalgia patients for many years. I know what I’ve learned from my patients, and I am thankful to them for that. I’ve literally treated several thousands of patients with fibromyalgia and other chronic painful conditions, and the vast majority of them have done quite well. Let’s read on and see where you stand with these conditions, and see where you can begin your journey to liberate you from pain.