Dr.'s Article Insulting Towards FMS Patients

Discussion in 'Fibromyalgia Main Forum' started by jhmitch, Apr 7, 2005.

  1. jhmitch

    jhmitch New Member

    No, it ISN'T your imagination. There are plenty of doctors who probably would rather treat patients with bubonic plague than see a steady stream of FMS patients.

    In a March 23rd, 2005, article in an online journal for rheumatologists, called "Joint and Bone," Dr John Luetkemeyer, (who runs a rheumatology practice in Pensacola, FL) wrote an article entitled:
    "Rheumatologists Are NOT The Doctors to Deal with Fibromyalgia" in which he made it fairly clear that FMS patients are not welcome in his practice except for an initial exam.

    It isn't too difficult to sense the distain Dr. Luetkemeyer holds both for the FMS diagnosis and for those with this disorder, after reading his article. In my next post are some quotes:
  2. jhmitch

    jhmitch New Member

    Here are some of the quotes from Dr. Luetkemeyer's article:

    "Every specialty has its Achilles' heel as it relates to "diagnoses" not supported by evidence-based medicine. In my opinion, it is time for rheumatologists to relinquish the responsibility of treating fibromyalgia patients."

    "A fibromyalgia patient referred to me is evaluated on a one-time basis to document the validity of the "label," and further follow-up is deferred to the primary-care physician. My desire to enter rheumatology was directly related to my interest in rheumatoid arthritis and the other inflammatory arthritides not chronic pain secondary to the hypothesized altered processing of pain heavily influenced by psychosocial problems evident in the vast majority of these patients".

    "I do believe there are patients who have widespread musculoskeletal pain attributed to a syndrome we call fibromyalgia. However, I do not believe rheumatologists should be the "main caregivers for these patients," as Pisetsky and others have suggested. We simply treat these patients by default.

    The main reason for my stance is the lack of any creditable evidence supporting fibromyalgia as a rheumatologic condition other than the existence of chronic pain. Although rheumatic diseases are often associated with chronic pain, the converse is not necessarily true. ...".

    "Fibromyalgia has an abysmal track record of treatment, and several hypotheses have fallen by the wayside. Low pain thresholds, poor sleep patterns, abnormal levels of homocysteine or substance P, etc, make for interesting discussions at Lunch with the Professor sessions, but there is little practical advice about treatment. Abnormal central processing of pain in fibromyalgia is now the topic du jour. ..."

    "However, over the years, I have noticed a change in the opinion of eminent rheumatologists regarding posttraumatic fibromyalgia and the concern that labeling patients with fibromyalgia potentially encourages them to "grow into" the label and remain unwell. Several years ago at a conference I attended, Dr Nortin Hadler (University of North Carolina, Chapel Hill) described fibromyalgia as SOOS (Syndrome Of Out of Sorts), and I believe this cannot be totally ignored in many of these patients, and no amount of medication will change their life-associated stresses."

    "... When medicinal therapy is recommended, it generally falls into the category of antidepressants and/or muscle relaxants. None of these therapeutic approaches requires the expertise of a rheumatologist. But also, there is a documented lack of success. For instance, Dr Frederick Wolfe (University of Kansas, Wichita) and colleagues found a lack of significant improvement in patients after 7 years of conventional treatment [1]. This failure on the part of the physician OR patient cannot be ignored."

    "Also, the US medicolegal system rewards patients for the ubiquitous diagnosis of "posttraumatic" fibromyalgia, despite the fact that no creditable evidence exists to support such claims. All of these developments have resulted in increased referrals of fibromyalgia patients to rheumatologists, to the point where the condition may constitute as much as one third of a rheumatologist's practice."

    " It is my policy to evaluate these very difficult patients while realizing fibromyalgia is a "diagnosis" of exclusion. If fibromyalgia is the label to be used, it is my belief that "a jog around the block or 20 laps in the pool can make a dent" in the low pain threshold and poor sleep pattern hypothesized in fibromyalgia. I also stress the importance of patients being responsible for their therapy (exercise, stress reduction) and not to rely on my prescription pad".

    "Quite frankly, fibromyalgia patients do not excite me and I elect to "weed" them out of my practice unless they are willing to do the things that might be successful in improving their quality of life. Needless to say, my success rate is no different than Dr Wolfe's experience. After all, aerobic exercise does not come in a capsule or scored tablet!"
  3. jhmitch

    jhmitch New Member

    Luckily, Dr. Luetkemeyer's article led to a rebuttal from another rheumatologist, Dr Murray Sokoloff, (University of New Mexico School of Medicine and in private practice in Santa Fe) who wrote:

    "I found many of Dr Luetkemeyer's remarks and opinions quite disturbing and even offensive. He certainly does not speak for me" (plus)

    "I wholeheartedly agree that Dr Luetkemeyer and the community in which he practices would be far better off if he avoided fibromyalgia patients if at all possible, and he probably would serve his community best if he would hang a sign on his front door saying "FIBROMYALGIA PATIENTS NEED NOT ENTER THESE DOORS."

    Amen, Dr. Sokoloff!

    So if you live in the Pensacola, FL, area, and happen to be referred to Dr. Luetkemeyer, you'll probably want to request another rheumatologist. One who is compassionate (like Dr. Sokoloff) and doesn't demean his patients or their disorders.

  4. katcoats

    katcoats New Member

    What an ass-clown. You could see the venom dripping from the words. But from personal experience I can tell you that he is not alone or a single voice.
  5. BxGirl

    BxGirl New Member

    What nerve! He is certainly an arrogant you-know-what! I think the only reason he feels that way is because the big-shot doctor can't help fibro patients and it messes up his "I am God" attitude.

    Now, on the other side of the coin, I will say that I've started to also think that rheumys are not the doctors we should be seeing. They can't address many of our issues - sleep problems, thyroid problems, adrenal problems, IBS, gastric problems. So what type of doctor do we see?

    His arrogance aside, he does have a point in that rheumys are not equipped to handle us. Who is qualified to deal with all of these symptoms?

    So far, I see a rheumy, family doctor, psychiatrist, podiatrist, gastroenterologist, and am next going to see an orthopedic doctor. Wouldn't it be nice if we could just package them all into one neat parcel and just see one doctor for everything?


    P.S. - I'm thinking of printing this article out and showing it to my rheumy and ask her what she thinks of it.[This Message was Edited on 04/07/2005]
  6. elliespad

    elliespad Member

    SOB, doesn't he?
  7. BxGirl

    BxGirl New Member

    And he certainly doesn't live up to the Hippocratic Oath! I'd go to a barber before I'd go to him!!!!


    P.S. - No insult intended towards barbers!!!!
  8. lillorilea

    lillorilea New Member

    Yes, that article is quite upsetting to say the least but it Kind of explains alot to me. Like the reason why my rheumy will only see me once a year (he says nothing he can do for fibro) and why my family doctor seems to be blowing me off. Been having some really bad spells, severe headaches, dizziness and falling down. Don't know what to do because my doctor won't even see me, just says part of fibro. I really wish there were Doctors that dealt with Fibro and all conditions related. Its no wonder why there is depression associated with Fibro. Your in so much pain and things are happening to you that you feel you have no control of and can't get the proper care needed to live normal lives..... God Bless All
    [This Message was Edited on 04/08/2005]
  9. jhmitch

    jhmitch New Member

    Thanks for your replies, Kat, BxGirl, Susi, and elliespad! Like you, I was disgusted after reading Dr. Luetkemeyer's opinion piece.

    In the same issue of this rheumatologist e-magazine was a survey. Out of a hundred plus medical professionals sampled, about 55% said rheumatologists should be the ones treating FMS and 45% felt they shouldn't. However, the survey didn't indicate which kind of doctor SHOULD be handling FMS. Apparently, we're the 'unwanted orphans' of the medical community (lol!).

    Yes, BxGirl, you hit the nail right on the head when you wrote:
    >>"He is certainly an arrogant you-know-what! I think the only reason he feels that way is because the big-shot doctor can't help fibro patients and it messes up his "I am God" attitude "<<

    >>"Who is qualified to deal with all of these symptoms? ... So far, I see a rheumy, family doctor, psychiatrist, podiatrist, gastroenterologist, and am next going to see an orthopedic doctor. Wouldn't it be nice if we could just package them all into one neat parcel and just see one doctor for everything?"<<

    It sure would! I see a GP, endocrinologist, rheumatologist, allergist, physical therapist, podiatrist, etc., and have always thought it would be wonderful to have "one-stop-shopping" rather than to have to bounce from one medical appointment to another.

    Even if I wasn't an FMS patient, Dr. Luetkemeyer would by my LAST choice for a physician. His general lack of compassion, his superciliousness, and obvious distain for many of his patients - comes through loud and clear in his article, and these aren't acceptable traits in any medical professional (or human being, for that matter).

    Thankfully, there are other doctors who lack the arrogance of this man. Hopefully, he is just a dinosaur of the medical profession and soon will be retiring.

  10. revlcb

    revlcb New Member

    Why doesn't he just admit that he's at a loss as to the treatment of FMS? It's the childs game of ignoring something that can't be fixed, or blame it on the other guy (patient).

    lillorilea, it's definately time to find a new Dr.!
  11. jbennett2

    jbennett2 New Member

    I can't believe the gall of that man to come out and say those nasty things. I'm glad I'm not his patient! Although I only saw my rheumy once (HMMM maybe her beliefs are the same), she told me my PCP would handle my treatment. I have gotten more help from my chiro. I believe this is because they actually see the person as a whole, and try to treat the whole person, rather than address one thing at a time.
  12. Mikie

    Mikie Moderator

    Rheumies, with a few exceptions, are good for diagnosing FMS but arent't usually the docs of choice for treatment. I don't know why this is true except that as this doc mentioned, rheumies train to fix arthritic conditions and FMS isn't an arthritic condition although many with it also suffer from OA and RA.

    Our illnesses are more neurological/immunological in nature, at least from the point of view of symptoms. Since no one knows what causes FMS, there is no specialty which is equipped to cure us. About the best we can do is treat the symptoms.

    Some docs, many of them very smart, have decided to specialize in FMS. Some are pain specialists and even a few are rheumies. My specialist is a physiatrist which is a doctor of physical medicine, kinda like a physical therapist with an M.D. Many specialize in sports medicine. Mine does a lot of the same things as orthopedists do. He is the one who just injected my knee with Synvisc. He previously injected my chest for costo chondritis.

    This doc is one of the best I have ever had treat me. He has no ego problems; listens to his patients; is kind, respectful, and considerate; is very knowledgeable but always interested in learning more; and is willing to try new things.

    Before I had this great doc, I had a great PCP who helped me with treatments which I researched myself. He had a good attitude too. I switched when I got Medicare and the Medicare HMO as he wasn't in the network. I have a good PCP and PA now too.

    For those who have a good rheumie, I'm happy for you. For everyone else, try to find a good specialist. If all else fails, try to find a good PCP who will help you with treatments. Sometimes, we have to see several specialists who treat only one or two of our symptoms. In other words, we need to be especially involved in our own treatment and do whatever it takes to try to heal.

    Tansy is an excellent example. She lives where the govt. is systematically trying to discredit CFIDS as an illness and there is little treatment available. She had done all her own research and found ways to treat herself. She is more knowledgeable than most docs you will encounter. Her posts are always a good read and well worth reading.

    Bigoty is always better out in the open like this doc. At least, we know where he stands and will avoid him and his kind.

    Love, Mikie
  13. Rosiebud

    Rosiebud New Member

    for decent, caring, understanding doctors like Doctor Solokloff(?). John Leutkemeyer doesnt deserve the title of doctor.