new_n_lost
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A 44-year-old school principal has symptoms of chronic fatigue and has not worked for one year. She is applying for long-term disability and asks you to complete a medical report for this. Physical examination is normal. The complete blood count, liver function tests, thyroid-stimulating hormone and erythrocyte sedimentation rate are all normal.
You should tell her that
1) She is not disabled because physical exam and test are normal.
2) Chronic fatigue syndrome is not a valid illness.
3) You will refer her for psychiatric evaluation.
4) You are not under any obligation to complete the report.
5) You will complete the report based on these findings.
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| keepgoing
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 what is the answer nnl..
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| new_n_lost
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Cmon Guys/ Gals start Thinking is Ethics Anyone else wants to comment.
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| usmle4me
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I think 5 seems resonable. tests done appear normal in chronic fatigue syndrome. and it is often diagnosed by exclusions.And it is a valid illness.
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| eytanraz
Forum Newbie
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I too think 5 is correct, but why not for a psichiatric evaluatioon?
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| doc179
Forum Guru
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yeah...I was also thinking about the psych consultation, I guess you are not supposed to refer your patients to other doctors unless you are not capable of treating their illness, like ophthal. anyway...I think I would go for 5 too.
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| silver
Forum Guru
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5
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| parnaprajapati
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5 seems pretty gud. no abnormality detected in labs.doc should always complete the report...doc179 answered very truly ....unless one's duties r over a doc should never refer to someone else.
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| keepgoing
Forum Guru
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mm i think i quitted quite early  yes 5th but i think psychaitric evaluation should be taken before writing in for disablity leave b/c it comes under differential diagnossi of MULTIPLE SOMATIC COMPLAINTS...juz my 2 cents...i may be fully wrong...as u all thinking for 5th right on explanatiion but can we think of this also i mean about MScomplaints????refereing to psychologist for evaluating?????????
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| new_n_lost
Politically InCorrect
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Sorry Guys Dont have the Asnwer to this one.
Chronic Fatigue Syndrome is a diagnosis of exclusion, The pt is a typical Cardiac A typee of a person who wishes to have his/her normal life back at home or at work. These patients are not malingerers, and they do not seek secondary gain. As a group, they want a fully functioning life restored, and they become frustrated by their inability to perform their work and home tasks because of their prolonged fatigue and cognitive dysfunction.
Patients with CFS may be depressed secondarily because of their inability to perform normal duties at home and at work, but they are not depressive individuals per se. Depressive individuals give a history of being depressed for many years, and they lack the cognitive dysfunction characteristic of individuals with CFS.
The Logical Answer is tht u complete ur report based upon findings n then refer her for a psych evaluation.
But I think it shud be C becos CFS should be diagnosed only after other causes of fatigue are excluded and the fatigue has lasted for at least 1 year. CFS may be excluded as a diagnostic consideration from patients with prolonged fatigue if they do not have cognitive difficulties.
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| Luckyall
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it is 5) " you WILL complete the report based on these findings " .. there is a committee to decide for her... is NOT your job... you just fill in the form your lab findings .. and THAS IT 
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| new_n_lost
Politically InCorrect
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U cant MAke a Diagnosis of CFS without Psychiatric Evaluation thats My Point
Now if u r going to say that she is not having CFS with Certainity then u need to excluded the Psychiatric component of the disease. She is asking u for UR opinion Will u amke a statement without considering every possibility abt a disease which is diagnosed solely after excluding all options.
My 2 cents
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| Luckyall
Forum Guru
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She is applying for long-term disability and asks you to complete a medical report for this. Physical examination is normal. The complete blood count, liver function tests, thyroid-stimulating hormone and erythrocyte sedimentation rate are all normal.
You cant refuse the pt.... she is applying... is okay...you dont need to come with the decision right now and here, even if you do come up with a decision, is useless, there is a committee for this you just fill out the form based on your own findings... DONT MAKE REFERRALS in USMLE exam...wrong option...
Edited by Luckyall on 05/02/07 - 10:42 PM
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| Mikeland
Forum Senior
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5
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| rock
Forum Elite
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i would pick 5
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