When to seek help

 The reality gap in Modern healthcare

iStock_000012218286SmallIf your doctor is dismissive of your symptoms you are likely to feel disenfranchised and isolated. It is abhorrent that people with symptoms of debilitating fatigue are sometimes treated in a dismissive or resentful way by healthcare professionals. This is a cultural failing in our healthcare system and we need to change the culture. You should be able to openly seek help and discuss non-specific symptoms with your doctor and generate a plan of action to investigate or treat the symptoms without being made to feel in some way inferior. If the latter occurs you should speak out. Sadly most people feel guilty or ashamed rather than angry when their symptoms are dismissed, so no solutions are reached and the discrimination continues.

One of the major problems in the assessment of fatigue is that fatigue is often surrounded by lots of non specific symptoms and these lead to confusion for the sufferer and their doctor. For the fatigued patient multiple symptoms often lead to increased anxiety. This, in itself, can contribute to waining quality of life and a need to share all symptoms in detail with the attending family doctor. This approach may be necessitated by the fear that one or another symptom may hold the key to an undiagnosed illness that might represent a “unifying diagnosis”.

For the doctor, gaining the full history of these symptoms often results in a very long prolonged consultation and frequently does not add to, or enhance the diagnostic process.

During the last 2 decades a number of changes in healthcare provision have occurred that have led to a treatment gap in modern medical care.

Sophistication in healthcare is improving, diagnostics have revolutionised management of many diseases and yet overall quality of life in our society has not improved as a result.

The Quick fix dilemma

In the absence of progressive symptoms or when standard investigations do not provide a tangible diagnosis, healthcare professionals become impotent, symptoms are often neglected or dismissed and no solutions are  sought.

The paradox here is that there are always underlying causes for ill health related symptoms but unravelling the cause is difficult and sometimes beyond primary care doctors and specialists alike.

There are a few reasons for this paradox. Firstly complex symptoms of ill health can be due to diseases affecting multiple systems and organs in the body. Because of supra-specialisation of doctors we are now not always able to put the illness jigsaw together. Secondly there are generally a combination of medical issues which (may be mild and subtle) and lifestyle issues. These can, when mixed together, produce a combination of symptoms, often centring around fatigue, that are more debilitating than would be expected from any one of the conditions standing alone. Thirdly and crucially doctors and patients alike sometimes avoid addressing or acknowledging complex lifestyle issues because there is not a simple medication or treatment that will result in a quick fix solution.

If you understand what you can do for yourself and what your primary care physician might be able to do when you seek help, this will make your consultations more meaningful and useful. If you have overwhelming and debilitating symptoms but your blood tests are normal it is very unlikely that one single unifying medical problem is causing your symptoms and your doctor is unlikely to cure your symptoms with a standard treatment. However a combination of you addressing behavioural and lifestyle factors and your doctor helping you with any medical issues should when combined enable recovery of well-being.

If you have symptoms of fatigue the first steps to working out what to do are to think about if the symptoms have been developing insidiously over a long period of time (months or years) or if they are new and if the fatigue is associated with any particular progressive symptoms of fatigue. Very long term symptoms that have fluctuated may be more likely to be influenced by your lifestyle than a progressive medical condition. If you have very long-standing symptoms and have experienced severe psychological trauma in the past, this, even if resolved and historic, can cause on-going symptoms of ill health. Therefore if you think this might be an issue you should discuss this with your primary care doctor.

Steps to help you diagnose yourself.

If your symptoms are of less than 3 months duration;

1. Do you have symptoms  that have progressed rather than being changeable over several weeks or months? Progressive worsening pain in one area (rather than all over varying pain), progressive weight loss, progressive loss of movement in one limb, progressive shortness of breath, a lump that is increasing in size, progressive abdominal swelling?

For symptoms centring around fatigue;

2.Do you have a boom bust lifestyle?

3.Do you have erratic sleep, sleep dysfunction?

4.Do you have an unbalanced diet, weight problem

5.Do you frequently use recreational drugs/ alcohol/ smoking as a coping strategy

6.Do you take very little regular exercise.

7.Have you experienced physical or psychological trauma in the past?

If you have any of the symptoms described in question 1. be advised that these are all symptoms that indicate that you need urgent assessment and investigation by a medical specialist.

If you answer yes to any of questions 2 to 7 then lifestyle, behavioural or psychological issues may be contributing to your on-going symptoms, even if they are not the underlying cause.

If you feel better and invigorated when you exercise and you have none of the problems described in question 1. above, it is possible that your problems are lifestyle related.

If  you answer no to question 1 and if exercise or strenuous physical and mental activity make your symptoms much worse, either immediately or the next day, and it takes a long time to get back to baseline, then it is possible that you are suffering from CFS/ME.

When you see your doctor try to understand that time may be limited. If there is no obvious medical diagnosis that the doctor suspects after assessment and no obvious lifestyle issues that could be contributing, then ask if CFS is possible and if you need to be seen by a specialist. The earlier that CFS and other medical diseases are diagnosed and treated the sooner your health and well-being will start to improve.

For more tips on this and other fatigue dilemmas add this site you your favourites. There will be more information and articles coming soon.



Dr Annice Mukherjee, Hormone Consultant & Fatigue Expert