Patients would trust their physician more, Hippocrates wrote, “if (a physician) is able to tell his patients when he visits them not only about their past and present symptoms, but also to tell them what is going to happen, as well as to fill in the details they have omitted”.
The medical method used today has endured since Hippocrates’ time; diagnose based on physical symptoms, then prognose based on prior similar cases. When we visit our doctor’s office, we expect our doctor to explain to us why we feel ill, how we will feel in the future, and what steps we can take to feel better. Our health providers and health systems are well-equipped to deal with diagnosable diseases where pinpointing a distinct etiology allows an entry point into which the disease is explained, treatment plans are suggested and probable outcomes are offered. Yet, for
1.3 million Canadians aged 25 or older who are affected by medically unexplained physical symptoms (MUPS)—conditions for which the medical majority has not adopted an exact cause, navigating the healthcare system is a struggle as these patients encounter
barriers to obtaining a diagnosisand
earning status as credible patients.
Though many symptoms are included under the MUPS umbrella, 1.3 million Canadians aged 25 or older are affected by
one of three MUPS conditions: myalgic encephalomyelitis (ME), fibromyalgia (FM), and multiple chemical sensitivity (MCS). Patient complaints that are not attributed to an identifiable cause, such as findings on medical tests or physical examinations, present significant challenges to the patients who suffer from these conditions, to the providers who are expected to treat them, and to the healthcare system where cost containment is a major priority.
For patients, there is a struggle to earn credibility among providers who may perceive their symptoms as less debilitating than symptoms occurring within the context of a ‘
hard’ pathophysiological finding. In the absence of a
narrative or vocabulary to explain their illness, many patients report feelings of
invalidation, guilt and hopelessness. Moreover, some providers might suggest that the illness is
entirely psychological which is both stigmatizing and inequitable, especially given the fact that most mental healthcare in Ontario is positioned outside the
boundary of medical coverage. Even the labelling of certain MUPS conditions is offensive and trivializing. For example, some people still refer to myalgic encephalomyelitis (ME) as chronic fatigue syndrome (CFS) which many patients feel minimizes their experience with the condition. Likewise, following the publication of 1980s’ Newsweek article, ME is sometimes flippantly labelled as “
Yuppie Flu” which implies that the condition is simply “a fashionable form of hypochondria”.
