Who Are the Key Players?
Not everyone who has fibromyalgia has the same type of doctors or health-care specialists. The physicians you see will depend on the symptoms you are experiencing and whether you can get satisfactory answers. A person who has irritable bowel syndrome, for instance, will need the expertise of a gastroenterologist, while a psychiatrist might be involved in treating depression.
When it comes to finding good doctors, it's critical to find those who acknowledge the reality of fibromyalgia. Many people, including those in the medical community, still don't believe that fibro exists. It doesn't seem to matter to them that fibromyalgia has been recognized as a bona fide medical problem by the World Health Organization, American Medical Association, and the American College of Rheumatology. These people still think that fibromyalgia is “all in your head.” But when you're in pain, the last thing you need is a health-care professional who disregards your complaints and treats them as hogwash.
It's also important to find doctors who are on top of the most current studies on fibromyalgia. Research into fibro is constantly evolving, and modern medical knowledge moves at a rapid clip. A doctor who stays on top of what's new is more likely to provide you with the best and most up-to-date care.
Finally, you want health-care professionals who are compassionate and understanding. Granted, not every good doctor is blessed with good bedside manners, and good technical expertise can usually compensate for a lack of warmth. But a caring physician can make it more appealing for you to go to the doctor. The following sections describe some of the key players you'll need.
Fact
Prepare for your first appointment by reading, “Choosing a Doctor,” a pamphlet written by the Agency for Healthcare Research and Quality. The pamphlet is available on the Internet at
The Primary Care Doctor
Whether it's your long-time family doctor, an obstetrician-gynecologist, or an internist, the lead doctor is your primary care doctor. This person is the one you summon first when you don't feel well or a new symptom emerges. The primary care doctor is the first person to evaluate your problems and determine whether they need further investigation. They often screen new symptoms to determine whether they are due to FMS or another condition. If it is another condition, they will determine which treatments should be provided. This doctor is also the “quarterback” of your team and will decide when you need to see a specialist, help steer you to the best, and coordinate the activities of your various treatment providers.
The Lead Doctor (Your “Fibrodoc”)
The lead doctor should be familiar with fibromyalgia or, at the least, have a desire to learn more about it. He could be your primary care doctor or a specialist, such as a rheumatologist, endocrinologist, physiatrist, or pain management doctor. Your fibrodoc might even be a chiropractor. The next sections describe health-care professionals who are most likely to treat people with fibromyalgia.
Rheumatologist
Many people with fibromyalgia wind up seeking out a rheumatologist. Rheumatologists specialize in the diagnosis and treatment of autoimmune disorders such as lupus, rheumatoid arthritis, and scleroderma. But they also treat people who have arthritis and musculoskeletal conditions, osteoporosis, and sports-related injuries.
After four years of medical school, and three years of training in internal medicine, rheumatologists spend another two to three years in rheumatology training. Most choose to become board certified, which requires passing a rigorous exam conducted by the American Board of Internal Medicine.
While in training, rheumatologists learn the skills it takes to become the medical detectives that their field demands. Unlike some doctors who focus on certain organs — such as neurologists, who treat brain disorders — rheumatologists treat conditions that involve numerous organs and body systems. They must also learn to read X-rays of joints and to understand the ways numerous medications work in the body.
But a skilled rheumatologist doesn't end his training with medical school or board certification. A good rheumatologist will stay on top of all the research and developments in medicine.
Family Practice Physician
Family physicians treat the whole person and the person's family. They do not restrict their practice to a certain age group, the way geriatricians do. And they don't confine their practice to one gender, the way obstetrician-gynecologists do. They're also not restricted to focusing on one particular organ or body system, the way cardiologists concentrate on the heart and the circulatory system.
Although the field is general in its scope, family practice still requires specialty training. After graduating from medical school, family physicians complete a three-year residency program and participate in inpatient and outpatient learning. They also receive training in pediatrics, obstetrics and gynecology, internal medicine, community medicine, surgery, psychiatry, and neurology. In addition, they are taught about several other aspects of medicine, including geriatrics, ophthalmology, radiology, orthopedics, and urology.
Fact
At the beginning of the twentieth century, 80 percent of all U.S. doctors were in general practice. By 1969, when the field of family practice was created, only 50 percent were generalists. Today, there are nearly 70,000 practicing family physicians in the United States. They make up 12 percent of all patient care physicians in the United States and are part of the 41 percent involved in primary care.
Internist
Doctors who treat adults are called doctors of internal medicine or internists, which is not the same as a medical intern in training to become a physician. Those who specialize in the nonsurgical treatment of diseases of the internal organs are known as internists.
These doctors devote their medical school training to the prevention, diagnosis, and treatment of diseases that affect adults. They are generally well rounded in their knowledge and are equipped to treat common problems involving the eyes, skin, ears, nervous system, and reproductive health. They are also expert at knowing when to defer to specialists when problems become complex. But they often remain involved in coordinating a patient's care. Internists who choose to pursue a subspecialty, such as cardiology, oncology, or infectious disease, go on to receive additional education and training.
Osteopathic Physician
Doctors of osteopathy (DOs) are just like medical doctors (MDs). They must complete four years of medical education and follow up with an internship and residency program. They often serve as primary care doctors and are able to prescribe medications and perform X-rays. They're licensed by states according to individual state regulations.
What makes DOs different from MDs is that their training emphasizes viewing the body as an integrated whole, with the whole being greater than the sum of its parts. Although MDs are taught this same lesson, there is less emphasis on the integrated approach to the body in traditional medical schools. Rather than just treat the symptoms affecting one body part or system, a DO will treat the whole person. The belief is that once the body is functioning properly, it can heal itself.
Osteopathic medicine also puts greater emphasis on prevention and health maintenance. Their treatment methods reflect that philosophy and may incorporate hands-on manipulation of bones and muscles, a procedure known as osteopathic manipulative treatment. These manipulations can be used to diagnose injury and illness, improve blood flow, and promote healing.
Fact
Osteopathy is not alternative medicine, though it was once considered quite radical. It was founded in 1874 by a physician named Andrew Taylor Still. Although initially regarded with skepticism, his ideas eventually took hold. In 1892, he started the American School of Osteopathy in Kirksville, Missouri. Today there are twenty colleges of osteopathic medicine — including the A.T. Still University in Kirksville — with nearly 10,000 students.
Obstetrician-Gynecologist (OB-GYN)
Some women with fibromyalgia turn to a trusted OB-GYN for their initial health problems. OB-GYNs are trained in the medical and surgical care of women, and they specialize in issues regarding reproductive health, including pregnancy, childbirth, and disorders of the reproductive system. They provide screenings of sexually transmitted diseases, preventive tests for breast and cervical cancers, and assistance with family planning.
Although OB-GYNs are not trained specifically to deal with FMS, they do treat women, who make up the bulk of people with fibromyalgia. Because of this, some OB-GYNs take the time and effort to learn a great deal about fibromyalgia. They may also be enlisted if someone with FMS develops vulvodynia or any other problem involving reproductive health.
Pediatrician
Children who are diagnosed with fibromyalgia may be under the care of a pediatrician. Pediatricians who cannot treat FMS may be able to refer your child to a pediatric rheumatologist or another specialist.
