Category: Medical Care

Chronic debilitating fatigue in Irish general practice: a survey of general practitioners’ experience

Abstract:

BACKGROUND: Doctors are called upon to treat chronic debilitating fatigue without the help of a protocol of care.

AIMS: To estimate the incidence of chronic debilitating fatigue in Irish general practice, to obtain information on management strategy and outcome, to explore the attitudes of practitioners (GPs) towards the concept of a chronic fatigue syndrome (CFS), and to recruit practitioners to a prospective study of chronic fatigue in primary care.

METHOD: A total of 200 names were selected from the database of the Irish College of General Practitioners (ICGP); 164 of these were eligible for the study.

RESULTS: Altogether, 118 questionnaires were returned (72%). Ninety-two (78%) responders identified cases of chronic fatigue, giving an estimated 2.1 cases per practice and an incidence of 1 per 1000 population. All social classes were represented, with a male to female ratio of 1:2. Eleven disparate approaches to treatment were advocated. Many (38%) were dissatisfied with the quality of care delivered, and 45% seldom or hardly ever referred cases for specialist opinion. The majority (58%) accepted CFS as a distinct entity, 34% were undecided, and 8% rejected it. Forty-two (35%) GPs volunteered for a prospective study.

CONCLUSION: Chronic fatigue is found in Irish general practice among patients of both sexes and all social classes. Doctors differ considerably in their management of patients and are dissatisfied with the quality of care they deliver. Many cases are not referred for specialist opinion. A prospective database is required to accurately assess the scale of this public health problem and to develop a protocol of care.

 

Source: Fitzgibbon EJ, Murphy D, O’Shea K, Kelleher C. Chronic debilitating fatigue in Irish general practice: a survey of general practitioners’ experience. Br J Gen Pract. 1997 Oct;47(423):618-22. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410094/ (Full article)

 

Chronic fatigue syndrome. Helping patients cope with this enigmatic illness

Abstract:

Chronic fatigue syndrome is a recurring, debilitating illness complicated by the fact that its diagnosis is largely based on subjective complaints and the absence of reproducibly reliable tests. There is no known “cure” for this illness; however, in general, the prognosis for patients is good. Some physicians accept the existence of chronic fatigue syndrome, while others are convinced that it exists only in the minds of its “victims.” The majority of physicians, however, are skeptical but open-minded and wish to help their chronically fatigued patients. As more information comes to light, it is likely that modern medicine will have to rethink its views on this elusive illness. In the interim, patients with chronic fatigue syndrome need the support and reassurance of their physicians to help them cope with their symptoms and resume normal, productive lives.

 

Source: Fuller NS, Morrison RE. Chronic fatigue syndrome. Helping patients cope with this enigmatic illness. Postgrad Med. 1998 Jan;103(1):175-6, 179-84. http://www.ncbi.nlm.nih.gov/pubmed/9448682

 

Chronic fatigue syndrome: sufferers’ evaluation of medical support

Abstract:

In response to reports of negative cooperation between sufferers of chronic fatigue syndrome (CFS) and their doctors, semi-structured interviews were conducted with sufferers from two different patient samples.

Satisfaction with support received and with medical professionals in general was low. Sufferers complained about insufficient informational as well as emotional support from their doctors, and as a consequence most opted for alternative or complementary forms of treatment.

In addition, disagreements over illness aetiology and treatment precluded effective cooperation. If satisfaction and compliance are to improve, sufferers will need more information about CFS and more support.

 

Source: Ax S, Gregg VH, Jones D. Chronic fatigue syndrome: sufferers’ evaluation of medical support. J R Soc Med. 1997 May;90(5):250-4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296257/ (Full article)

 

Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome

Abstract:

To what extent do personal constructs affect the relationship between doctor and patient when the ill patient does not readily recover with treatment?

Questionnaires were returned anonymously by 609 patients with a self-reported diagnosis of chronic fatigue syndrome, who were considered chronically ill. Findings were compared with those of an earlier study of a population of 397 general medical patients.

The chronically ill patients lost an average of 65 days of work per year due to illness compared to general medical patients who missed six or fewer days per year because they were ill. The chronically ill patients also reported a 66% higher frequency of iatrogenic illness, spent more money on health care, took more medication, saw more specialists, and were more litigious than the general medical population.

Research suggested several patterns of relationships between doctors and patients, and attitudes to health and illness, which may alert doctors to patients’ perceptions, beliefs, encoded constructs, and patterns of relating that affect responses to treatment. More attention by doctors to patients who are experiencing the stress of chronic illness is indicated.

 

Source: Twemlow SW, Bradshaw SL Jr, Coyne L, Lerma BH. Patterns of utilization of medical care and perceptions of the relationship between doctor and patient with chronic illness including chronic fatigue syndrome. Psychol Rep. 1997 Apr;80(2):643-58. http://www.ncbi.nlm.nih.gov/pubmed/9129381