ME/CFS because they say patients only want research patients agree
with or rather research that relates to their experience as the expert
on their own experience. Rather than being confined to patients alone
it could be said as well that researchers/clinicians also only cite
research they agree with or research that aligns with their particular
point of view. It appears to be a human condition.
The paper states that the WHO categorized CFS under neurological
disorder (G93.3) despite there being no evidence that ME/CFS is
neurological. It seems rather odd to say that the World Health
Organization would not have used scientific evidence in assigning
diseases to categories and no evidence that this is actually the case
is presented.
Oxford Journals InnovAIT
Chronic fatigue syndrome
Dr Jeremy C. Gibson
Ms Bozena Smith
Prof Christopher D. Ward
Department of Rehabilitation Medicine, Royal Derby Hospital, Derby
Chronic Fatigue Syndrome Service, Royal Derby Hospital, Derby
Department of Rehabilitation Medicine, Royal Derby Hospital, Derby
Rehabilitation Research and Education Group, University of Nottingham
Abstract
In this article, we outline GP management of chronic fatigue syndrome
(CFS), the condition also known colloquially in the UK as =91ME=92. The
paper is based on National Institute for Health and Clinical
Excellence (NICE) guidelines and also incorporates evidence-based
strategies available to specialist services. GPs are well placed to
make an early diagnosis of CFS and give patients helpful advice to
manage their fatigue, hopefully avoiding multiple inappropriate
referrals to specialist medical clinics.
The paper states in part:
The GP curriculum and chronic fatigue syndrome:
GP curriculum statement 13 - Care of people with mental health
problems states that GPs in training should be
able to manage patients presenting to general practice with a history
of chronic fatigue or =91tired all the time=92. In particular, GPs in
training should be able to:
Manage people experiencing tiredness in primary care, bearing in mind
that several interventions may be effective, including different forms
of talking therapy, medication and self-help
Describe the need to check for psychological illness while avoiding
the habit of checking extensively for physical
illness
Show that they understand that ideas about the physical, psychological
and social should be integrated in both consultation and investigation
of illness
...Although there is no evidence that CFS is a neurological
condition, the World Health Organization (WHO) has
categorized it as neurological (G93.3). However, the Royal College of
General Practitioners (RCGP) classifies fatigue
within its mental health curriculum statement.
(www.rcgp.org.uk/pdf/educ_curr13%20Mental%20Health%20Jan%2006.pdf. The
statement refers to the undifferentiated lack of energy relating to
depression whereas ME/CFS patients specifically experience post
exertional exhaustion lasting 24-hours or more, unrelieved by rest,
upon minimal exertion. It also codes Chronic Fatigue Syndrome under
mental health disorders F286 stating that Eu Read code maps exactly to
the ICD 10/DSM IV code. CFS however is not listed in the DSM IV and
under the ICD-10 as noted by the authors themselves it is coded under
G93.3.) Some members of the NICE Guideline Development Group (GDG)
felt that until further research identifies aetiology and
pathogenesis, the guideline should recognize the WHO classification.
Others felt that to do so did not reflect the nature of the illness.
Practically, as in the management of
other medically unexplained symptoms where the goal is improved
function, perhaps the precise diagnostic category to which CFS is
attached is unhelpful....
...What attitude should GPs have?
It is important to remember that people with CFS want to be taken
seriously, so show that you believe them. Doctors can
make a difference to patients=92 well being even when they cannot
explain their symptoms medically. Therefore, concentrate on managing
symptoms and improving function.
The doctor=96patient relationship is vital in this, so ensure that you
connect with patients by listening carefully to their beliefs about
their symptoms. Allow patients to recap their
view of the situation and share your action plan with patients, making
it goal centred and aiming for functional improvement. The recent RCGP
publication on medically
unexplained symptoms provides useful advice in this area.
(www.rcgp.org.uk/PDF/MUS_Guidance_A4_4pp_6.pdf)
http://rcgp-innovait.oxfordjournals.org/content/early/2011/07/07/innovait.i=
nr073.abstract
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