The Realities and Challenges of Managing Fibromyalgia in Palestine: A Qualitative Study

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Ameed Taher
Ezzideen Malhis
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Introduction: First conceptualized in the 1970s, Fibromyalgia (FM) is the second most common condition observed by rheumatologists, with an estimated global mean prevalence of 2.7%. Despite that, it is still underdiagnosed, and its legitimacy questioned. Patients with FM are often stigmatized due to the lack of clearly defined symptoms and pathophysiology, and the psychologizing of the condition. Knowledge deficiencies and negative attitudes among physicians toward FM have been demonstrated in several countries. This study aims to explore Palestinian physicians' knowledge, educational experiences, clinical practice behaviors, and attitudes regarding FM. Methods: Physicians in different specialties who were most likely to care for patients with FM were purposively sampled and consented to participate in semi-structured interviews. Interviews were audio recorded and transcribed and a thematic content approach to analysis was used. Results: Fourteen physicians in Palestine were interviewed. Three themes and seven subthemes were identified from the interviews: knowledge and attitudes (subthemes: educational realities, physicians' attitudes toward FM), approach to clinical care and related issues (diagnosis and etiology of FM, management of FM, unwillingness to manage FM patients), and challenges (doctor-patient relationship, adequacy and acceptance of psychological services). Conclusion: Knowledge deficiencies and negative attitudes about FM were common among the Palestinian physicians we interviewed, even in those specialties deemed most likely to make the FM diagnosis. The inadequacies of healthcare (too many patients and too little time), the lack of psychological services, and the misunderstandings about mental health in Palestine were thought to affect the education of future physicians and the quality of care for FM patients.