Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and h

[JaimeS]

Full Title:

Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?
http://bjgp.org/content/66/649/437

Quick little article, but shockingly published by a British journal, it offers the following advice to clinicians:

"In order to minimise iatrogenesis, GPs require better training in how to diagnose CFS and communicate with patients with CFS; GPs should not seek to impose a biopsychosocial model of illness on a patient. Models of illness should not supplant the ‘lived experience of illness’ or subjugate the expert status of the patient as ‘witness to their condition’. Nassir Ghaemi, critical of the biopsychosocial model, suggests doctors should consider alternative clinical approaches, such as Karl Jaspers’ ‘method-based’ or William Olsen’s ‘medical humanist’ model’.14 Such models might be used by GPs to:

• inform patients of the absence of known aetiology in CFS (rather than speculating around psychogenic causes);

• inform patients that there are explanations for some CFS symptoms (for example, the IOM report of biomedical evidence);

• offer patients treatments such as CBT, but inform patients that these therapies do not work for all (rather than suggesting the patient controls outcomes);

• offer alternative interventions and support, such as counselling and community care (rather than just referral to CFS clinics); and

• accept the legitimacy of the patient account (rather than seeking to challenge patients’ illness beliefs).

"Such differences of approach may seem subtle, but arguably represent a more pragmatic approach, which we recommend for general practice. It is probable that harm could be minimised by adopting a more concordant model that includes patients’ preferences in treatment and management."

This article is like "maaaaaybe they're not cray-cray" but it's better than a lot of what's published. Thanks to the author for knowing about the IOM report at all, for referencing the patient survey showing harms of GET (though the numbers seem VERY off), and in general saying "if we don't know what it is, then that's what you should tell the patient".

 

[daisybell]

@JaimeS this is the article by Keith Geraghty - there's a thread about it somewhere...

 

[Denise]

Full Title:

Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?
http://bjgp.org/content/66/649/437

Quick little article, but shockingly published by a British journal, it offers the following advice to clinicians:

"In order to minimise iatrogenesis, GPs require better training in how to diagnose CFS and communicate with patients with CFS; GPs should not seek to impose a biopsychosocial model of illness on a patient. Models of illness should not supplant the ‘lived experience of illness’ or subjugate the expert status of the patient as ‘witness to their condition’. Nassir Ghaemi, critical of the biopsychosocial model, suggests doctors should consider alternative clinical approaches, such as Karl Jaspers’ ‘method-based’ or William Olsen’s ‘medical humanist’ model’.14 Such models might be used by GPs to:

• inform patients of the absence of known aetiology in CFS (rather than speculating around psychogenic causes);

• inform patients that there are explanations for some CFS symptoms (for example, the IOM report of biomedical evidence);

• offer patients treatments such as CBT, but inform patients that these therapies do not work for all (rather than suggesting the patient controls outcomes);

• offer alternative interventions and support, such as counselling and community care (rather than just referral to CFS clinics); and

• accept the legitimacy of the patient account (rather than seeking to challenge patients’ illness beliefs).

"Such differences of approach may seem subtle, but arguably represent a more pragmatic approach, which we recommend for general practice. It is probable that harm could be minimised by adopting a more concordant model that includes patients’ preferences in treatment and management."

This article is like "maaaaaybe they're not cray-cray" but it's better than a lot of what's published. Thanks to the author for knowing about the IOM report at all, for referencing the patient survey showing harms of GET (though the numbers seem VERY off), and in general saying "if we don't know what it is, then that's what you should tell the patient".

Existing thread about this article http://forums.phoenixrising.me/inde...y-k-j-gerathy-and-a-esmail.45956/#post-746987