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Who is on Your Medical Team? Roles a primary care physician and various specialists can play in a Fibromyalgia patient’s care. From the Fibromyalgia Friends Support Group of Nevada1

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By Mervyn Willard, MD, and Patti Wright • www.ProHealth.com • August 25, 2006


Which professionals belong on your medical team? First, a primary care physician (PCP) who is willing to help you bring your FM symptoms into a manageable range, and then, as needed, specialists who can help you “whittle away at” those symptoms.

Roles of the PCP

This is an internist, family physician, or ambulatory care physician who performs several roles. These roles may be summarized as follows:
n Preventive check-ups. Often the PCP follows national guidelines for cholesterol and laboratory testing, PAP and mammograms, screening for colon cancer – such as those published by the U.S. Preventive Services Task Force [at the Agency for Healthcare Research & Quality Web site, www.guideline.gov].
n Treatment of acute illnesses or injuries, for which an office visit may suffice.
n Treatment of chronic (ongoing) illnesses, by following you at regular intervals once management of the illness is in “maintenance” phase.
n Referral to specialists. The PCP in many instances is in an excellent position to select a specialist with skills matching your needs. After the referral, the primary physician keeps up with your case through reports from the specialists.
n Obtain authorization for you to see a specialist. Some insurance companies do not permit you to see a specialist without being first sent by your PCP.

Often, referrals must come through the primary care physician for insurance reasons. Note, though, that patients may make requests to the primary physician. It may serve you well to check things out ahead of time. When the time comes, you may already know specific specialists’ names to bring up with your primary care doctor.

Roles of Specialists
The types of specialists that may be able to help you, or that your PCP may send you to, include the following:

1. Pain Management Consultant. This physician, using medicines and often using techniques for regional pain control, works to bring your pain to a more tolerable level.

2. Physical Medicine and Rehabilitation (PM&R) Specialist. Also called a Physiatrist. PM&R specialists have a strong background in muscle and skeletal disorders. Some (but not all) work with FM patients.

3. Neurologist (a nerve and brain specialist). May be called in to help with neurological disorders distinct from FM, and with migraine or other types of headaches. (But seldom do they manage FM by itself.)

4. Rheumatologist (arthritis specialist). Sometimes manages FM, but sometimes only diagnoses it and sends the patient back to the primary doctor. Rheumatologists willing to treat FM can be very helpful. Those who only diagnose it can be helpful in doing this if the diagnosis is in question.

5. Physical Therapist using manual techniques such as Strain-Counterstrain [look for information about this on the Web]. A Chiropractor may also be skilled in manual techniques. But care is required in selecting a therapist because FM does not respond to the usual therapies used in most offices. FM symptoms may flare if inappropriate techniques are used. Therefore inquire first. Does the office use manual techniques? And avoid facilities that are not trained in this area.

6. Physical Therapist specializing in balance training. For those FM patients who experience difficulty with equilibrium, or fall easily.

7. Ob/Gyn Specialist. May be particularly helpful in balancing hormone problems associated with painful menses, or with peri-menopausal or post-menopausal symptoms.

8. Gastroenterologist. Specializes in digestive tract. May be called in to help with digestive problems, including irritable bowel syndrome.

9. Family Therapist and Psychologist. Always included in the recommended list of specialists. However, this is an entire topic unto itself, beyond the scope of “the medical team.”

______

1. This article is reproduced with permission from the August 2006 issue of the Fibromyalgia Friends Support Group of Nevada Newsletter. Mervyn Willard, MD, is a member of the FMFSG Advisory Panel, and Patti Wright is the group’s founder and leader. See also the accompanying article by these authors, “Basic Training on How to Find Your Physician.” For information about the FMFSG, its meetings in the Las Vegas area, and its monthly newsletter, e-mail Founder and Leader Patti Wright fmangels3@cox.net or Administrator Christy Noble at noblpeople@aol.com .

Note: The information provided here is not intended to diagnose, treat, cure, mitigate, or prevent any disease. Consult your physician for medical advice.




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