Paper short abstract:

Fibromyalgia is considered a borderland situation between normality and pathology. All this ambiguity is present in diagnosis which, more than the determination of a morbid condition, ends up being a classification of patient-doctor interaction and a moral characterisation of the sick person.

Paper long abstract:

Background: Fibromyalgia is considered a borderline situation between normality and pathology. The aetiology, whether physical or psychological, and the diagnostic procedures of this condition are contested by biomedicine. The absence of any objective test or specific biological marker that allows diagnosis in an unequivocal form adds to the ambiguity of the condition. This study focuses on the process of negotiation of this diagnostic category and the problems arisen from the lack of objective tests for pain.

Methods: Fieldwork carried out over a six month period in two different outpatient settings in Spain, a rheumatology clinic and a psychiatric clinic. Participant-observation was used to explore doctor-patient interaction and the diagnostic process of fibromyalgia.

Results: Fibromyalgia diagnosis is usually carried out solely on the basis of the patient's narrative of symptoms (without physical exploration). Throughout the diagnosis process some psychological and social characteristics are automatically attributed to fibromyalgic patients and they are conceptualized as conflictive. On occasions this labelling masks the diagnosis or confuses it with other physical conditions.

Conclusions: Fibromyalgia, due to problems both in aetiology and diagnostic procedures, is used as a label to classify doctor-patient interaction and as a moral characterization of the sick person. In this paper I will argue that the diagnosis of fibromyalgia supposes a conflict between sufferers and physicians. Doctors seek to avoid this situation by the concealment of the diagnosis or diagnosing another disease more coherent with their medical speciality model.