The first unbiased assessment of fibromyalgia.

This compelling account of the author's experience with a chronic pain disorder and subsequent interaction with the American health care system goes to the heart of the workings of power and culture in the biomedical domain. It is a medical whodunit full of mysterious misdiagnosis, subtle power plays, and shrewd detective work. Setting a new standard for the practice of autoethnography, Susan Greenhalgh presents a case study of her intense encounter with an enthusiastic young specialist who, through creative interpretation of the diagnostic criteria for a newly emerging chronic disease, became convinced she had a painful, essentially untreatable, lifelong muscle condition called fibromyalgia. Greenhalgh traces the ruinous effects of this diagnosis on her inner world, bodily health, and overall well-being. Under the Medical Gaze serves as a powerful illustration of medicine's power to create and inflict suffering, to define disease and the self, and to manage relationships and lives. Greenhalgh ultimately learns that she had been misdiagnosed and begins the long process of undoing the physical and emotional damage brought about by her nearly catastrophic treatment. In considering how things could go so awry, she embarks on a cogent and powerful analysis of the sociopolitical sources of pain through feminist, cultural, and political understandings of the nature of medical discourse and practice in the United States. She develops fresh arguments about the power of medicine to medicalize our selves and lives, the seductions of medical science, and the deep, psychologically rooted difficulties women patients face in interactions with male physicians. In the end, Under the Medical Gaze goes beyond the critique of biomedicine to probe the social roots of chronic pain and therapeutic alternatives that rely on neither the body-cure of conventional medicine nor the mind-cure of some alternative medicines, but rather a broader set of strategies that address the sociopolitical sources of pain.

Medically unexplained symptoms and somatisation are the fifth most common reason for visits to doctors in the USA, and form one of the most expensive diagnostic categories in Europe. The range of disorders involved includes irritable bowel syndrome, chronic widespread pain and chronic fatigue syndrome. This book reviews the current literature, clarifies and disseminates clear information about the size and scope of the problem, and discusses current and future national and international guidelines. It also identifies barriers to progress and makes evidence-based recommendations for the management of medically unexplained symptoms and somatisation. Written and edited by leading experts in the field, this authoritative text defines international best practice and is an important resource for psychiatrists, clinical psychologists, primary care doctors and those responsible for establishing health policy.

As many as fifteen million American women, or 5 percent of the adult female population in the US, suffer from the disabling medical condition known as fibromyalgia. If one takes into account husbands, partners, children, and other close relatives, the proportion of the American population directly or indirectly affected by fibromyalgia could be as high as 10 percent, or thirty million persons.Nonetheless, the medical community is divided over the reality of this condition. One side argues, sometimes heatedly, that the patients are masquerading - pretending a disability they know they do not have. The other side counters, with equal passion, that fibromyalgia sufferers are abused by a society that fails to give them the support they deserve while painfully suffering from this severely debilitating illness.Without taking sides, Dr. M. Clement Hall presents six fictional, though factually based, case studies of typical patients from differing socioeconomic backgrounds and describes the varying investigations, diagnoses, and treatments they have undergone. Each of these case studies represents a composite of many years of clinical practice rather than one specific patient. Collectively, they cover the range of experiences fibromyalgia patients are likely to have encountered.By taking this unique approach, Dr. Hall presents an objective overview of the fibromyalgia situation today in North America. Patients, family members, and physicians will see themselves reflected in the descriptions and will gain a broader understanding of this challenging illness.M. Clement Hall, MD (Toronto, Ontario, Canada), now retired, was the director of continuing education in the emergency department of Scarborough Hospital. He is the author of Trauma Surgeon, among numerous other works.

Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological - rather than psychological - nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome proposes new diagnostic clinical criteria for ME/CFS and a new term for the illness - systemic exertion intolerance disease(SEID). According to this report, the term myalgic encephalomyelitis does not accurately describe this illness, and the term chronic fatigue syndrome can result in trivialization and stigmatization for patients afflicted with this illness. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome stresses that SEID is a medical - not a psychiatric or psychological - illness. This report lists the major symptoms of SEID and recommends a diagnostic process.One of the report's most important conclusions is that a thorough history, physical examination, and targeted work-up are necessary and often sufficient for diagnosis. The new criteria will allow a large percentage of undiagnosed patients to receive an accurate diagnosis and appropriate care. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder; enhance public understanding; and provide a firm foundation for future improvements in diagnosis and treatment.

Caring for patients with fibromyalgia requires an understanding of the complex nature of this condition. Fibromyalgia: A Practical Clinical Guide is a state-of-the-art resource designed to clarify the controversy about fibromyalgia and to provide clinicians with the latest information about its pathogenesis and clinical evaluation, as well as evidence-based guidelines for effective treatment. This comprehensive title includes fully referenced, practical information on this fast-emerging field and provides useful clinical suggestions and practical office tools for effectively managing patients. The good news for fibromyalgia patients and their healthcare providers is that a wide range of medication, non-medication, and non-traditional therapies have been proven to effectively reduce some of the most problematic and disabling fibromyalgia symptoms. Brief case vignettes help describe many of the common presentations, concerns, and complexities typically seen in fibromyalgia patients. Invaluable graphic aids -- boxes, tables, and figures – are used widely to provide quick reference for the busy clinician seeking information. In addition, clinic-proven assessment and documentation tools for evaluating and monitoring fibromyalgia symptoms and severity are provided, along with handouts for patients to provide guidance on pain management techniques, including detailed exercise and relaxation technique instructions. A unique addition to the literature, Fibromyalgia: A Practical Clinical Guide is an indispensable reference for all clinicians who care for patients with fibromyalgia.

In By the Bedside of the Patient, Nortin Hadler places current efforts to reform medical education--from the undergraduate level through residency programs and on to continuing medical education--in historical context. In doing so, he traces the evolution of medical school curricula, residency and fellowship programs, and the clinical practices they promoted. Hadler examines crucial junctures in history to locate the seeds for reform. Some believe that medical education and training should highlight literature, ethics, and culture, while others emphasize science and efficiency to abbreviate the time from entry to licensure. Neither of these approaches, Hadler argues, maintains or improves patient care, which should be at the core of medical education and practice. Hadler contends that most reform attempted thus far constitutes, at best, little more than a reshuffling of the basic curriculum and, at worst, an augmenting of medicine's predilection to measure, grade, and record. Examining generational changes in medical education, Hadler mines sixty years of training and practice to identify mistaken approaches and best practices. Ultimately, in the contemporary era of managed care, Hadler argues for a clinical practice that draws on the best available scientific knowledge, transmits the wisdom of experienced clinicians, reforges an empathetic relationship between physician and patient, and treats each patient as an individual--all centered on restoring the mandate to care.