Overcoming the barriers to the diagnosis and management of CFS/ME in primary care

[Bob]

I thought I'd seen this somewhere on the forum, but i can't find it, so here it is...

It's another attack on the 'biomedical model' of ME, this time by UK authors...

I don't think i'm familiar with the authors. It anyone else?


Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies.
Bayliss K, Goodall M, Chisholm A, Fordham B, Chew-Graham C, Riste L, Fisher L, Lovell K, Peters S, Wearden A.
7 March 2014
BMC Fam Pract. 2014 Mar 7;15(1):44.
http://www.biomedcentral.com/1471-2296/15/44

Full PDF:
http://www.biomedcentral.com/content/pdf/1471-2296-15-44.pdf

Abstract
Background
The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.

Methods
A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.

Results
Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.

Conclusions
In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.

 

[Dolphin]

I don't think i'm familiar with the authors. It anyone else?

A lot of them were involved with the FINE Trial ...

 

[barbc56]

Is the study saying that since doctors don't know about me/cfs it's psychological or are they saying to look at the whole picture which includes biological plus any mental conditions?

TBH, I can't make heads or tails of this and can't download the pdf, atm.

If a doctor needs to look at the whole picture, will they also refer us to a dental clinic an?

I think not.

Barb

 

[Bob]

@barbc56, I haven't read the full paper yet, but the abstract simply asserts that CFS/ME is best treated via a 'bio-psychosocial' approach. Considering the authors, I suspect this actually means via a 'psychosocial' approach, without the 'bio'. In other words, via normal NHS treatments: CBT/GET/pain meds.

It's ground-breaking stuff!

 

[peggy-sue]

"A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input."

Bolding in that quote from the Conclusions part, by me.
I would re-interpret that to mean that gps need to pay more attention to the nasty little videos produced by nurse chalder on how to flannel your patients with philospohical arguments about dualism (disguised as monism) and mind-body theories.

I know my gp has watched them. He didn't know that I was well enough educated to be able to see right through it and have the counter arguements ready.

 

[daisybell]

From a quick glance through, this reads like sitting on the fence.... The authors seem to be trying to appease both the doctors and patients. Which of course ends up satisfying neither for the main part.

 

[peggy-sue]

We've seen this all before. Loads and loads of times.

The "difficulties" are all caused by our being unwilling to accept that it is all in our heads.

This is merely about how they are going to carry on gaslighting more effectively.