Vagueness in current diagnoses

First, I apologize for not writing a new blog for quite some time. I have been extremely busy lately. Secondly, I wish to bring up the simplification of medicine that is occurring with the dumbing down of education. It appears that schools are trying to compartmentalize medical problems into simple algorithms. This simplification extends to diagnoses as well. Recently, the diagnostic criteria for both fibromyalgia and migraines have been altered to a more meaningless definition. In the past, fibromyalgia required at least a defined number of trigger points in multiple quadrants of the body for such a diagnosis. Recently, one society has changed the diagnosis to a more vague definition of just chronic muscular pain. With the new current diagnosis, essentially everyone could have fibromyalgia. This is a sad state of affairs since already too many people are getting dumped in the fibromyalgia box. Don’t get me wrong, I believe in fibromyalgia but I also believe that 90% of the people diagnosed with it by their primary care doctors don’t actually have it. It concerns me because we are putting people into a diagnosis that has no cure and essentially limited options. As I tell my patients before I put you into that box, I want to make sure that you don’t have a treatable condition. Our current treatments for fibromyalgia are essentially just a few medications and generally, narcotics are not recommended for treatment of this disorder. I generally disapprove of the changes in the diagnosis algorithm and I feel that this is just to make things easier so people don’t have to try and diagnose people’s problems. As for migraines, the same is true. Migraines in the past were vascular headaches. There was a definitive difference between migraines and tension headaches. Migraines, were usually one sided and intermittent in nature, similar to cluster headaches. Recently, the diagnosis has changed to essentially imply that any headache is a migraine. Tension headache, which are treated differently, now could be diagnosed as migraines easily. Worst of all, most migraine medication will work on any headache. Again, let’s make treatment of people simple so people don’t have to think about it. Essentially, that is what the Medicare people have told me. They state that everything is in an algorithm now and that we as doctors should just follow the algorithm and not be concerned about complicated studies. I believe all of this is in the name of saving money but it does nothing to help resolve people’s problems. I still go by the old diagnoses for these disorders since I believe that people deserve the opportunity to have their problems treated and not just managed. Nonetheless,I see this simplification is the future.

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