What is chronic fatigue syndrome and how could one of those gals on the U.S. women's soccer team have it and still play? I don't get it!
I am sick and tired of chronic fatigue. Talk about mass hysteria, this is a case of a non-diagnosis becoming a national epidemic. You can thank a bunch of self-important doctors and ill-informed, self-righteous support groups revving up a populace primed to enjoy poor health. If crucifixes were still in vogue, I am sure that there would be no shortage of volunteers.
Once upon a time chronic feelings of lassitude, lack of energy, generalized aches and pains and sleep disturbances were considered typical of depression. In fact, when I was in medical training, the euphemism was "masked depression," which meant that the doctor recognized that the patient was depressed, but the patient didn't. Of course, forgive me for saying this, but such a diagnosis presumed that the doctor might know something about the patient that the patient didn't know. That was a perfectly reasonable presumption until psychiatry went into the toilet. Now you can't tell people they're depressed. You need a new medical vernacular. Hmmm. Let's see. How about Chronic Fatigue Syndrome (CFS)?
"Way excellent," said the pseudo wise men.
The term means NOTHING.
In what we call CSF, there are no specific lab-test abnormalities or alterations in muscle function. If you have any question about the non-physiological nature of the fatigue, watch an elite-class athlete compete day after day in Women's World Cup soccer, functioning at a physical-fitness level most of us can't even imagine, yet she is feeling that she is ill. Right ... And Tiger Woods should be able to hit the ball 50 yards farther.
In all fairness, there are plenty of well-respected physicians who firmly believe that CFS is real. And, perhaps for a small minority of patients with the complaint of chronic fatigue, there is a yet-undiscovered physiological basis. Perhaps, perhaps. I am not convinced. The last word is not in, but my last words on the subject: Freud was plenty wrong, but better than many of the alternatives. Recommended link: Depression in Primary Care, Vol 1.
Why are doctors so defensive when the patient asks lots of questions and does his own research?
Why shouldn't we be? What gives you, the intelligent, well-informed patient, the right to think that you are actually capable of conversing with HMO-crazed, constantly harassed, so-
Medicine is a fraternity. No one can join without proper hazing. Pay your dues, then we will listen.
By the way, would you mind covering for me this weekend? I've got two tickets to the Stones. Just slip on my white coat and keep talking over the patients. No one will know the difference. Besides, you already have all the answers.
A practical tip: Doctors are human, are exactly the same as the rest of us/them/me/you, but have been tainted by a taste of power and drama unequalled in any other profession. It's only natural that they (to varying degrees) believe their own sales pitch. If you want the best care, ignore their pomposity and imperiousness. Pretend that they are maitres d' and that they are going to get you the best seat in the health restaurant. Seduce them with compliments, a gracious smile, a thank-you note. Once you have them on your side, anything goes. You can send back the wine, rip up the tablecloth or bring in a zillion questions.
Another tip: If possible, interview your general practitioner before signing on. Offer to pay for the time. Most blind dates start over coffee, not by going directly to the pelvic and rectal exams. Don't be shy or coy in the beginning. Think colonoscopy, and ask every question that stands between you and comfort. Remember, you are hiring the doctor.
About the writer
Robert Burton is a physician in San Francisco.
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