Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care, 2014, Bayliss et al

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

Kerin Bayliss, Mark Goodall, Anna Chisholm, Beth Fordham, Carolyn Chew-Graham, Lisa Riste, Louise Fisher, Karina Lovell, Sarah Peters & Alison Wearden

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.

https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-15-44

 

This study identifies there was in 2014 significant issues in current medical practise around diagnosis and understanding of ME, but I am not sure how this justifies the widespread introduction of a controversial BPS understanding of the condition.

I am not sure how identifying deficits in management of ME/CFS justifies what with our current knowledge ignores what establish facts we have and then undertaking what would consequently amount to unevidenced indoctrination.

 

Not sure they are really entitled to B, either, given the battlegrounds over criteria, and over conflation with chronic fatigue/TATt.

 

Substantial misdiagnoses regarding ME vs. other diseases noted in "Misdiagnoses on a grand scale?" on the ME Research UK website.

This article notes 2 studies. Several people diagnosed with "cfs" actually had other diseases. I will add the link to this article later.

(Perhaps BPS practitioners are 100% correct in their diagnoses, and it's just biomedical practitioners who misdiagnose ME as a biomedical disease....)

ETA: https://www.meresearch.org.uk/research/other-resources/misdiagnosis-on-a-grand-scale/

 

Yes 2014 - I came across it today while looking at references for : https://www.s4me.info/threads/a-com...t-no-me-cfs-diagnosis-2022.30840/#post-450787

I've posted this on the recent study thread:

There's a major structural inconsistency. While Bernhoff et al rely on Bayliss et al to invoke a biopsychosocial approach, Bayliss et al being reliant on NICE 2007, (see post 2 above) Bernhoff et al also rely on NICE 2021 as a reference for:

"The findings of impaired physical ability being characteristic in ME/CFS are, as could be expected, in accordance with previous studies [39]." Ref 39 = Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management

yet Bernhoff et al make no attempt to account for the significant changes between the 2007 and 2021 Guidance, notably the downgrading of the two key BPS associated interventions of CBT and GET, this despite the fact that Bernhoff et al's reference 3 is to the very fact of these changes:

"In recent years, chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), hereinafter referred to as ME/CFS, has been, and continues to be, a debated field [1,2,3]." Ref 3 = ME exercise therapy guidance scrapped by health watchdog Nice

Perhaps Bernhoff et al intend their phrase "a more flexible biopsychosocial approach is recommended" to address the change in NICE Guidance without having to acknowledge it outright. Though they might have given some clue as to 'more flexible than what ?' or 'more flexible toward what ?'.

 

Only glanced at this - bio-psychosocial - why not take your bio-psychosocial and e.g. apply it to Alzheimer's ---- surely we shouldn't be the sole recipients of your bio-psychosocial contribution ---- oh it doesn't work ---- well then why apply it!
All for caring for people i.e. where you currently cannot provide effective treatments but you can apply techniques such as GWAS to understand diseases e.g. as illustrated by the recent migraine GWAS study ---- that way you could potentially find effective treatments!

Unbelievable!