Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia.

Observed Findings

• Physicians expressed greater skepticism toward CFS than fibromyalgia, viewing them as less serious than conditions with formal disease status.
• Physicians characterized patients with these conditions as ambitious, active, illness-focused, demanding, and overly medicalizing.
• Physicians developed various coping strategies to manage encounters with these patients, suggesting the interactions caused professional role strain.
• Patients with CFS and fibromyalgia did not uniformly gain access to the sick role in physician interactions.
• Physicians made moralistic interpretations of patients, distinguishing between conditions with illness versus disease status.

Inferred Conclusions

• Diagnostic uncertainty about ME/CFS and fibromyalgia creates professional dilemmas that cause physicians to question their ideal role and develop ad-hoc coping strategies.
• Physician skepticism and moralistic characterization of patients may be partially rooted in the lack of formal disease classification for these conditions.
• The gap between ideal and real physician practice suggests systemic barriers in how healthcare providers are trained to recognize and validate these conditions.
• Patients with ME/CFS and fibromyalgia face socially constructed barriers to legitimacy in healthcare beyond the biological nature of their illnesses.

Remaining Questions