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On CFS and biopsychosocial model in BJGP by K. J. Gerathy and A. Esmail

Discussion in 'General ME/CFS News' started by Kalliope, Jul 29, 2016.

  1. Kalliope

    Kalliope Senior Member

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    Last edited: Jul 29, 2016
    Yogi, SilverbladeTE, Woolie and 14 others like this.
  2. hixxy

    hixxy Senior Member

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    Will see if I can get a full article. No promises. It's dated 1st of August which hasn't even passed yet.
     
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  3. Sasha

    Sasha Fine, thank you

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    @Keith Geraghty is a member of this forum.

    Congratulations on your publication! :thumbsup:
     
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  4. Richard7

    Richard7 Senior Member

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  5. Keith Geraghty

    Keith Geraghty Senior Member

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    hi, my article should be available here to read

    http://bjgp.org/content/66/649/437

    please feel free to write an e-letter expressing your views of the BPS model and GP care to the BJGP if you'd like your views expressed online for other readers/GPs to see
     
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  6. hixxy

    hixxy Senior Member

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    At what point do "medically unexplained symptoms" become "medically explained symptoms"?
     
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  7. ScottTriGuy

    ScottTriGuy Stop the harm. Start the research and treatment.

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    @Keith Geraghty

    Thanks for writing about the harm we experience from the healthcare system.

    I'm confused by something and hope you can clarify.

    Why does your article's title include 'chronic fatigue syndrome' and use that term throughout the article yet in the opening paragraph you state:

    "In the 1980s, doctors combined theories of neurasthenia, hysteria, and somatoform illness, to reconstitute ME as ‘chronic fatigue syndrome’."

    It would seem more accurate to use ME.

    Thanks.
     
  8. Simon

    Simon

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    Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm? | British Journal of General Practice
    (freely accessible full text - edit: ah, this is the one Keith mention above so assume is correct)

    Abstract

    In 1977 George Engel wrote about the need for an ‘integrated approach’ in medicine that moved the focus beyond biological mechanisms of disease to include all pertinent aspects of illness presentation, setting out a ‘biopsychosocial model’.1 Around the same time, McEvedy and Beard asserted that the disease ‘benign myalgic encephalomyelitis’, described by Ramsay at the Royal Free Hospital, London, was nothing more than a case of ‘mass hysteria’.2 In the 1980s, doctors combined theories of neurasthenia, hysteria, and somatoform illness, to reconstitute ME as ‘chronic fatigue syndrome’. Psychiatrists argued that CFS was best understood using a biopsychosocial (BPS) framework, being perhaps triggered by viral illness (biology), but maintained by certain personality traits (psychology) and social conditions (sociology).3 Although the BPS model holds much utility in understanding ‘illness’ in a wider context, many sufferers of CFS reject the notion that their illness is psychologically or socially derived. Significant numbers of patients report difficult interactions with doctors that leave them feeling dissatisfied, disbelieved, and distressed. In this article, we question whether or not the BPS model generates ‘harms’ for CFS patients, and we ask if other, alternative approaches might be more preferable to both patients and GPs.
     
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  9. Keith Geraghty

    Keith Geraghty Senior Member

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    thank you for the question - CFS is the term generally used by GPs working in the frontline NHS. This was a debate article that allowed a very short word limit of just 1200 words (which I exceeded). There was not enough space to develop a discussion relating to the distinction between names ME and CFS - and all that this entails. I would have preferred to use the term ME, but I used the term GPs would use in practice - CFS.

    I have a follow-up long version article on harms - which looks at the terminology of ME/CFS and talks about the types of harms patients endure/experience - I hope it gets accepted for publication shortly.

    This short BJGP article was a step towards getting GPs to debate why patients with CFS or ME, report harms and dissatisfaction? - could it be the biopsychoosical model and what alternative models could be used?
     
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  10. Dr Speedy

    Dr Speedy

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    Yes Simply getting us proper treatment; CBT and GET are ineffective and useless; GET is very harmful and breaches the Do no harm principle of Medicine
     
  11. Simon

    Simon

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    @Jaime posted this on a duplicate thread, but I think it's worth repeating the suggestion on @Keith Geraghty 's paper. Just sensibly honest and practical advice emphasising what little is known, rather than presenting a shaky theory with weak results as the definitive answer:

    "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."
     
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  12. Dr Speedy

    Dr Speedy

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    I'm sorry to say but CBT for this disease is ineffective, totally useless and a total waste of time and money. So I do not understand why you think it's important to repeat that message; the PACE trial has clearly shown that CBT and GET are ineffective so people should stop promoting those treatments ...
     
  13. Jeckylberry

    Jeckylberry Senior Member

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    Perhaps the inclusion of the CBT line is that his audience are practitioners who hold beliefs that, a. CBT is a legitimate, standard treatment and b. anything that dismisses it is suspicious and casts doubt on the whole article. We know CBT doesn't work but blunt opposition to it is useless. You can't stray too far from accepted norms because it risks being discounted all together. The writer is diluting its importance which will be more effective in the long run.

    I think the acceptance of CFS/ME as a chronic illness with some successful remission, rather than curable with some stubborn cases, will help to reduce the blame/shame cycle that is going on to date.
     
  14. Dr Speedy

    Dr Speedy

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    No it would be more effective to use the PACE trial and it's null effect and not reinforce the nonsense about CBT and continue to waste money on ineffective treatment
     
  15. Yogi

    Yogi Senior Member

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    I just wanted to second Sashas congratulations.

    Some may feel that it should be worded more strongly and deal with all the historic injustice.

    Given the bias in British medical journals this was no mean feat.

    Congratulations and Well done @Keith Geraghty for managing to get this published.!!!!!!
     
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  16. Yogi

    Yogi Senior Member

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    Anyone know the answer to this given science for diseases are always developing and old theories give way to new?
     
  17. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    My answer to that would be:

    1. When someone publishes a paper with new information about previously unexplained symptoms now comprising a new disease. This would be an outstanding contribution to science.
    OR
    2. When your doctor has determined that your previous unexplained symptoms are actually caused by a known disease, such as MS or hereditary mitochondrial illness, or whatever. For example, in your medical chart, the ICD code for "unexplained fatigue" would be removed and then replaced by the new ICD diagnostic code.
     
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  18. Glycon

    Glycon World's Most Dangerous Hand Puppet

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    This article does not appear to be "freely available" any longer, FYI.
     

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