Article:

Should rheumatologists retain ownership of fibromyalgia? A survey of Ontario [Canada] rheumatologists

– Source: Clinical Rheumatology, May 2, 2012

By S Ghazan-Shahi, et al.

[Note: “The issues are now on the table,” Margaret Parlor, president of Canada’s National ME/FM Action Network (www.mefmaction.com) commented on Friday, May 4. She notes that these views likely represent those of physicians in other provinces, and given that fibromyalgia patients “already have a high level of unmet needs,” the possibility of current services being withdrawn without others to replace them is a serious issue indeed.]

Abstract:

Fibromyalgia is a controversial widespread chronic pain disorder that includes a wide constellation of somatic and emotional symptoms. This study surveyed the opinion of Ontario [Canada] rheumatologists with respect to their beliefs about the nature and management of fibromyalgia.

A key objective was to ascertain if rheumatologists should continue to be the main care providers for these patients.

A survey comprising 13 questions was sent electronically to all 150 Ontario rheumatologists. The questionnaire was designed to obtain:

• Demographic data,

• As well as opinions regarding different aspects of fibromyalgia.

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Data were analyzed descriptively, and comparisons were made using chi-square tests. A total of 80 respondents completed our survey for a completion rate of 53%. The majority had completed their training in Canada (85%) and had been practising for more than 15 years (50%).

Key findings were:

1. 71% believe that rheumatologists should not retain ownership of fibromyalgia,

2. 55% believe that fibromyalgia is primarily a psychosomatic illness as opposed to a physical illness,

3. 89% believe that the family physician should be the main care provider for these patients,

4. Rheumatologists who consider fibromyalgia to be a physical illness were also significantly more likely to believe that rheumatologists should retain ownership of this disease (p=0.023) and were more likely to continue managing these patients in their practice (p=0.011).

The majority of Ontario rheumatologists do not wish to retain ownership of fibromyalgia. However, most of them continue to manage these patients, even though they believe that the family physician should be the main care provider for patients with fibromyalgia.

Rheumatologists may be providing care to these patients primarily because this care is not available to them from their primary care physicians.

[Note: A free access editorial commentary on this report – “Should Rheumatologists Retain Ownership of Fibromyalgia?” – notes that primary care doctors in general are getting pretty good at diagnosing fibromyalgia (average 70% correct), leaving 30% of cases without proper diagnosis. And PCs generally can’t manage FM effectively. What’s needed, in their opinion, is a drive to educate “treating physicians regarding differential diagnosis of diffuse pain syndromes, awareness of confounding conditions, and appreciation of treatment options, which should be tailored to individual patient needs.”]

Source: Clinical Rheumatology, May 2, 2012. PMID:22547393, by Ghazan-Shahi S, Towheed T, Hopman W. Internal Medicine, Queen’s University, Kingston, Canada. [Email 6sg36@queensu.ca]