Medical Care – Page 13 – American ME and CFS Society

Chronic Fatigue Syndrome: a survey of GPs’ attitudes and knowledge

Abstract:

BACKGROUND: GPs need evidence and guidance to help them diagnose and manage Chronic Fatigue Syndrome (CFS)/ME appropriately.

OBJECTIVES: The aim of this survey was to obtain baseline data and identify the factors associated with GPs’ attitudes to and knowledge of CFS/ME. The attitude of GPs to the condition is an important indicator of likely prognosis.

METHODS: A postal questionnaire was sent to 1054 GPs served by Taunton, Bristol and Gloucester laboratories. GPs’ attitudes to nine statements about CFS/ME were assessed and the factors associated with positive or negative responses were determined. Knowledge of the clinical features was also assessed.

RESULTS: 811 GPs (77%) returned the questionnaire. 48% of GPs did not feel confident with making a diagnosis of CFS/ME and 41% did not feel confident in treatment. 72% of GPs accepted CFS/ME as a recognisable clinical entity and those GPs had significantly more positive attitudes. Three other key factors that were significantly, positively associated with GPs’ attitudes were knowing someone socially with CFS/ME, being male and seeing more patients with the condition in the last year.

CONCLUSION: Despite the publication of guidance for GPs on CFS/ME, confidence with making a diagnosis and management was found to be low. Educational initiatives and guidance for GPs should stress the importance of accepting CFS/ME as a recognisable clinical entity, as this is linked to having a positive attitude and could lead to improved confidence to make a diagnosis and treat CFS/ME patients.

Source: Bowen J, Pheby D, Charlett A, McNulty C. Chronic Fatigue Syndrome: a survey of GPs’ attitudes and knowledge. Fam Pract. 2005 Aug;22(4):389-93. Epub 2005 Apr 1. http://fampra.oxfordjournals.org/content/22/4/389.long (Full article)

Supporting people with severe myalgic encephalomyelitis

Abstract:

This article aims to raise nurses’ awareness of myalgic encephalomyelitis (ME) also known as chronic fatigue syndrome (CFS). Key symptoms are presented along with possible service responses and treatment options. It emphasises that this condition is often misunderstood but that it can be serious and more research is needed to promote better understanding of the physical symptoms.

Source: Crowhurst G. Supporting people with severe myalgic encephalomyelitis. Nurs Stand. 2005 Feb 2-8;19(21):38-43. http://www.ncbi.nlm.nih.gov/pubmed/15727017

General practitioners’ perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

Abstract:

OBJECTIVES: To compare general practitioners’ perceptions of chronic fatigue syndrome and irritable bowel syndrome and to consider the implications of their perceptions for treatment.

DESIGN: Qualitative analysis of transcripts of group discussions.

PARTICIPANTS AND SETTING: A randomly selected sample of 46 general practitioners in England.

RESULTS: The participants tended to stereotype patients with chronic fatigue syndrome as having certain undesirable traits. This stereotyping was due to the lack of a precise bodily location; the reclassification of the syndrome over time; transgression of social roles, with patients seen as failing to conform to the work ethic and “sick role” and conflict between doctor and patient over causes and management. These factors led to difficulties for many general practitioners in managing patients with chronic fatigue syndrome. For both conditions many participants would not consider referral for mental health interventions, even though the doctors recognised social and psychological factors, because they were not familiar with the interventions or thought them unavailable or unnecessary.

CONCLUSIONS: Barriers to the effective clinical management of patients with irritable bowel syndrome and chronic fatigue syndrome are partly due to doctors’ beliefs, which result in negative stereotyping of patients with chronic fatigue syndrome and the use of management strategies for both syndromes that may not take into account the best available evidence.

Comment in: Patient organisations in ME and CFS seek only understanding. [BMJ. 2004]

Source: Raine R, Carter S, Sensky T, Black N. General practitioners’ perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study. BMJ. 2004 Jun 5;328(7452):1354-7. Epub 2004 May 28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC420289/ (Full article)

Paediatrician cleared of serious professional misconduct

A teenager who had been bedridden with chronic fatigue syndrome (CFS) for two years this week lost her High Court challenge to a decision by the General Medical Council to clear a paediatrician who tried to influence her treatment against her parents’ wishes.

Lawyers for the 18 year old, named only as Miss A, argued that the decision to find Christopher Cheetham not guilty of serious professional misconduct was legally flawed because the GMC had not considered whether he had been acting in breach of confidence.

But the judge, Mr Justice Charles, said the GMC had been concerned with a charge of serious professional misconduct, not an action for breach of confidence. The breach of confidence argument had not been advanced before the GMC, and it was under no duty to consider whether the charge of serious professional misconduct could have been established in an alternative way.

Dr Cheetham, then consultant paediatrician at Wycombe General Hospital, High Wycombe, saw Miss A at the age of 12 in 1997. She was bedridden with the illness from June 1997 to mid-1999 but has now substantially recovered.

The paediatrician, now retired, advocated an inpatient programme of psychotherapy and physiotherapy. Her parents disagreed, believing the illness was organic and she should be treated at home.

They withdrew consent for Dr Cheetham’s involvement in her treatment and consulted another paediatrician, who agreed that she should be treated at home under the care of her GP.

But Dr Cheetham disagreed with the treatment and continued to try to influence it for a further two years, writing letters to doctors involved in Miss A’s care. He also tried to access her medical records without consent and asked for test results.

You can read the rest of this article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC403879/

Source: Dyer C. Paediatrician cleared of serious professional misconduct. BMJ. 2004 May 1;328(7447):1035. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC403879/ (Full article)

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

Abstract:

Encountering patients with chronic fatigue syndrome (CFS) or fibromyalgia can cause dilemmas for physicians due to the uncertainty inherent in these illnesses. The aim of this study was to investigate: (1). How physicians in a Swedish sample describe and categorize patients with CFS and fibromyalgia; (2). What the character of CFS and fibromyalgia, with regard to diagnosing, treatment and medical knowledge/aetiology, mean to the physicians in encounters with patients; and (3). Which strategies physicians describe that they use in the encounter with these patients.

Semi-structured interviews were carried out with 26 physicians, specialists in various fields who all had some experience of either CFS or fibromyalgia. The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients. This may lead to the professional role being questioned. Different strategies are developed to handle the encounters with these patients. The results also illuminate the physician’s interpretations of patients in moralising terms. Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status. Scepticism was expressed regarding especially CFS, but also fibromyalgia.

Moreover, it is shown how the patients are characterised by the physicians as ambitious, active, illness focused, demanding and medicalising. The patient groups in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases.

Source: Asbring P, Närvänen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003 Aug;57(4):711-20. http://www.ncbi.nlm.nih.gov/pubmed/12821018

Chronic fatigue syndrome – medical fact or artifact

Abstract:

Despite extensive investigation, the enigma of Chronic Fatigue Syndrome (CFS) continues to confound medical researchers. It is suggested that this may be due to two impediments inherent in their overall approach to the problem.

Firstly, although fatigue is central to CFS, medical scientists appear not to understand what fatigue itself really is, nor what is its purpose or mode of function. A functional definition of fatigue is suggested to help resolve this.

Secondly, physicians and other researchers – psychologists and alternative medicine practitioners – fail to observe an elementary and fundamental procedure of clinical medicine, namely, that of properly examining their patients before making a diagnosis or providing treatment. The notion of the ‘black hole’ of medicine is introduced. Recognizing the existence of these impediments is considered a self-evident precondition for further significant progress being made in this field.

Source: Eidelman D. Chronic fatigue syndrome – medical fact or artifact. Med Hypotheses. 2003 Jun;60(6):840-2. http://www.ncbi.nlm.nih.gov/pubmed/12699708

AIDS and CFS/ME: a tale of two syndromes

Abstract:

Both HIV/AIDS and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) presented major challenges for medicine, science and society. This article explores what could have impeded investigation of–and specifically pharmaceutical engagement with–CFS/ME, in contrast to the impressive achievements seen in HIV/AIDS. It explores the obstruction of mind-body dualism in a historical context, and examines some of the possible obstacles to pharmaceutical enquiry. Nothing of real substance is identified that would justify the lack of investment and interest in solutions for patients with CFS/ME.

Comment in: AIDS and CFS/ME. [Clin Med (Lond). 2003]

Source: Pinching AJ. AIDS and CFS/ME: a tale of two syndromes. Clin Med (Lond). 2003 Jan-Feb;3(1):78-82. http://www.ncbi.nlm.nih.gov/pubmed/12617422

Editorial on CFS was biased, inaccurate, and misleading

EDITOR—As a member of the chief medical officer’s working group on chronic fatigue syndrome, I consider that Straus has failed to appreciate the difficulties of deciding what constitutes evidence in an illness as uncertain and heterogeneous as this.1 He also misunderstood, or took out of context, some of the key conclusions and recommendations in the chief medical officer’s report.

Although it was agreed that evidence should not just be limited to the results of randomised controlled trials, the findings of the York systematic review were frequently cited. It was therefore disingenuous of Straus to state that information from this review did not influence the report’s conclusions about a wide range of therapeutic interventions. It did.

Equally, it would have been a serious omission if the report had failed to refer to the feedback from patients contained in three large surveys on attitudes to management, as well as two events where patients and carers met with the working group. All three surveys concluded that graded exercise as is currently being done made more people worse than any other intervention. Pacing, however, was found to be beneficial by around 90% of respondents. By dismissing such views as anecdote, Straus fails to appreciate that the Department of Health is encouraging patients to enter into a therapeutic relationship with the medical profession in the management of chronic conditions such as this.2

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122848/

Source: Shepherd C. Editorial on CFS was biased, inaccurate, and misleading. BMJ. 2002 Apr 13;324(7342):914. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122848/ (Full article)

Recognising chronic fatigue is key to improving outcomes

Comment in: Caring for patients with chronic fatigue syndrome. Conclusions in CMO’s report are shaped by anecdote not evidence. [BMJ. 2002]

The government has finally issued its long awaited report on the management of chronic fatigue syndrome (also known as myalgic encephalomyelitis, or “ME”), after delaying publication earlier this month because several committee members resigned (5 January, p 7).

The report says that health professionals should recognise the condition as a chronic illness and that early recognition is key to improving outcomes.

Speaking at the launch, chief medical officer Professor Liam Donaldson acknowledged that the three years spent drawing up the report had been “enormously difficult, complex, and at some times controversial.”

“I’ve received a large amount of correspondence about this,” he said, admitting, “I’m a little surprised we have been able to get such a comprehensive and valuable report.”

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122065/

Source: Eaton L. Recognising chronic fatigue is key to improving outcomes. BMJ. 2002 Jan 19;324(7330):131. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122065/ (Full article)