New CPD learning module on CFS for GPs (UK)

[charles shepherd]

UK GP publication - PULSE - launches a new CPD learning module on CFS and places it in the mental health section (Clinical modules > Mental health)


http://pulse-learning.co.uk/clinical-modules/mental-health/cfs-case-based


PREMIUM
Case-Based Learning
Chronic fatigue syndrome
Module summary
This case-based module will guide you through the latest evidence in the diagnosis and management of fatigue and chronic fatigue syndrome.
Learning objectives
This module will update you on:

• The difference between fatigue and simple tiredness
• Factors in the history that may suggest chronic fatigue syndrome
• What basic investigations to do
• When to refer a patient with suspected chronic fatigue syndrome
• The evidence based management for chronic fatigue syndrome

Author
This module has been developed by Pulse Learning’s team of medical writers and editors, and peer reviewed by our GP advisers

I have not registered and paid to do this module as I do my CPD learning elswhere - but will try to have a look at it next week

Dr Charles Shepherd
Hon Medical Adviser, MEA

 

[worldbackwards]

...and back to reality.

 

[Tilney]

This module would appear to give 1.5 hours CPD credit
The module advertised on the same page for other mental health issues - "social anxiety disorder" appears to give 2 hours CPD credit.
Does the amount of hours credit attainable relate to the "importance" my GP should place on the condition?
If so would I be correct in saying if you have a limited budget treating CFS is below the need to treat social anxiety disorder?

 

[daisybell]

This module would appear to give 1.5 hours CPD credit
The module advertised on the same page for other mental health issues - "social anxiety disorder" appears to give 2 hours CPD credit.
Does the amount of hours credit attainable relate to the "importance" my GP should place on the condition?
If so would I be correct in saying if you have a limited budget treating CFS is below the need to treat social anxiety disorder?

Let's hope so if the module trots out the usual CBT and GET stuff, which I expect it will......

 

[wastwater]

By showing evidence of impact you get double points,I would like to see that filled in honestly.

 

[charles shepherd]

This module would appear to give 1.5 hours CPD credit
The module advertised on the same page for other mental health issues - "social anxiety disorder" appears to give 2 hours CPD credit.
Does the amount of hours credit attainable relate to the "importance" my GP should place on the condition?
If so would I be correct in saying if you have a limited budget treating CFS is below the need to treat social anxiety disorder?

The number of CPD points that a doctor gets for completing the module and answering the questions that follow relate to the length of the module/time taken to complete the module - not the importance of the subject.

All UK doctors now have to go through a complex and time consuming process of yearly appraisals which build up to a more major revalidation process at less frequent intervals in order to remain on the GMC register.

One part of the yearly appraisal process is collecting at least 50 CPD learning credits form attending lectures, going to meetings etc.

So your assumption is not correct!

 

[charles shepherd]

I'm afraid that most doctors, medical magazines/journals and other medical opinion makers just aren't aware of the debate and problems regarding issues like the PACE trial and still believe that the NICE guideline on ME/CFS remains a perfectly acceptable basis for diagnosing and managing patients with ME/CFS.

I will be writing to the editor of PULSE over the weekend to complain about the way they have incorrectly classified ME/CFS as a mental health disorder.

Dr Charles Shepherd - Hon Medical Adviser, MEA

 

[daisybell]

Thank you @charles shepherd

 

[Battery Muncher]

Thank you for your continued advocacy, Dr Shepherd.

 

[Dolphin]

E-mail sent out:

From: "Pulse Education" <PulseEducation@email.cogora.com>

Subject: Chronic fatigue syndrome or ME - what's the correct name?

[..]

New this week: chronic fatigue syndrome, prescribing in older patients

Chronic fatigue syndrome - heartsink, or a condition GPs should avoid getting downbeat about, given the experience reported by patients? It's one of those issues that provokes debate, for both doctors and patients. There are some who question whether it's a real condition at all, much to the chagrin of those who suffer from it. Add to that the ongoing controversy over whether it should be called chronic fatigue syndrome or myalgic encephalomyelitis, and GPs have a host of problems before we even begin to think about diagnosis.

Pulse Learning's new module on chronic fatigue syndrome even discusses the terminology and naming, such is the trouble it can cause, as well as everything else you would expect from a module, including diagnosis and primary care management options.

 

[Snow Leopard]

Has anyone actually reviewed the module and seen the content?

 

[trishrhymes]

I tried joining up to read it, but it's not one of the free 10 modules you get when you join, and I can't justify to myself paying to join as a full member, as I'm not a doctor. I hope someone else has the time and money to read it and can let us know how bad it is and put in a protest if necessary. Thank you Dr Shepherd for saying you will write to them about the mental health classification. This is so important.

 

[Esther12]

imo: They should provide the details for a patient group to review.

The BMJ called for a 'patient revolution' - letting patients see what doctors are being taught about them seems the bare minimum.

 

[charles shepherd]

Letter now sent to PULSE:

Dear Pulse Learning

Re Case based learning on CFS: http://pulse-learning.co.uk/clinical-modules/mental-health/cfs-case-based

I am not currently registered with PULSE to do your CPD learning modules and have not therefore gone through this new learning module on ME/CFS.

I am, however, very concerned to see that this module has been incorrectly inserted into the 'mental health' section of your learning modules.

As I am sure the authors of the module are aware, ME is classified as a neurological disease by the World Health Organisation (WHO) in their International Classification of Diseases (>> ICD10 section G93:3) and that this WHO neurological classification is accepted by the Department of Health, NHS etc. CFS is linked to this ME classification in ICD10.

In addition, the most recent report - Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - on ME/CFS from the Institute of Medicine in America states quite clearly that ME/CFS (or systemic exertion intolerance disease/SEID - as they have recommended as a new name for ME/CFS) is not a psychological or psychiatric condition. It is a complex multisystem medical disease.

IoM Report:
http://www.ncbi.nlm.nih.gov/pubmed/25695122
www.nap.edu/html/19012/MECFScliniciansguide.pdf


There are obviously disagreements and uncertainties surrounding many aspects of ME/CFS.

However, if GPs are going to immediately start off by working on the incorrect basis that they are dealing with a mental health/psychiatric condition, this will not only lead to conflict with patients. It will also lead to inappropriate and possibly harmful advice on management.

I will try and look at the module during the coming week.

In the meantime, please could it be inserted into a section covering neurological and/or immunological disease - where it belongs.

You may also be interested in this press release on last week's Freedom of Information tribunal judgement relating to the PACE trial and the use of two controversial treatments for ME/CFS - CBT and GET.

Press release:
(Removed from further distribution - as this is not yet in the public domain)

Regards
Dr Charles Shepherd
Hon Medical Adviser, MEA

MEA website: www.meassociation.org.uk

 

[trishrhymes]

Brilliant. Thank you Doctor Shepherd.

 

[charles shepherd]

Exchange of correspondence with the clinical editor of PULSE learning:


22 August
Hi Dr Shepherd,


Thanks for your email about the CFS module. I have added a neurology category to the module, but have kept the mental health tagging on it as well, so it will now sit in both specialties.




Kind regards,
David


David Swan
Clinical editor, Pulse


23 August

Dear Dr Swan

Thank you for relocating this module into neurology.

However, it should NOT be in mental health at the same time and should therefore be removed from this mental health tagging as well.

I will have a look at the complete module later in the week because, as I'm sure you are aware, the are major concerns in the patient community about:

1 the length of time it takes for a diagnosis of ME/CFS to be made - hence our 2016 campaign on early and accurate diagnosis:
http://www.meassociation.org.uk/201...nals-that-could-improve-prognosis-9-may-2016/
2 misdiagnosis
3 harmful or inappropriate advice on management
4 lack of NHS referral services in many parts of the UK - they are almost non existent in Scotland, Wales and Northern Ireland (and the Isle of Man)
5 the appalling situation regarding the lack of practical support along with the medical neglect of many people who are severely affected by ME/CFS

These are all important issues relating to primary care that PULSE magazine might like to pursue?

Regards

Dr Charles Shepherd
Hon Medical Adviser, MEA

 

[trishrhymes]

@charles shepherd, I wonder whether you were able to find the time to review this module.

I have been reminded about it because when you first flagged it up here I tried to see the module by signing up for their offer of free access to 10 modules for a limited time. However, the ME/CFS module was not included in the 10, so I forgot about it.

I have recently had a series of e-mail reminders asking if I wanted to pay for full access. I ignored these, but had a phone call yesterday from Pulse. I explained I'm not a doctor but particularly wanted to see this module and she promised to send me an e-mail with a week's free premium access so I could see it. This hasn't happened.

I went back on the website just now, and looked at the comments by users of the module. All but one were positive, saying it was useful. The one that stood out as different and alerted me to follow it up said this:

'I appreciate it has been done, my daughter has had ME for 16 years to date, and some of the advice and evidence I have found to not be in line with my experience, observations and reading.'

I strongly suspect the module simply repeats the NICE guidelines or worse. Also some did mention that the module was helpful because it was 'case based'.

I am reluctant to pay for membership of something I won't use and will probably only serve to upset me to no good purpose.

I wonder whether you, or any of your colleagues might be able to pursue this if you have time. Or if you have already done so, could you tell us about it?

 

[Binkie4]

Thank you @trishrhymes. I think this is a really important issue @charles shepherd.