"Subacute fatigue in primary care – two sides of the story" (corresponding author: Moss-Morris) 2019

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Dolphin

Senior Member (Voting Rights)
Open Access: https://onlinelibrary.wiley.com/doi/full/10.1111/bjhp.12361
Subacute fatigue in primary care – two sides of the story
Katrin Hulme
Paul Little
Abigail Burrows
Anna Julia
Rona Moss‐Morris
First published: 08 March 2019
https://doi.org/10.1111/bjhp.12361



Abstract
Objectives
Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner (GP) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved.

Design
A qualitative study design was used. In‐depth, semi‐structured telephone interviews were conducted with 14 patients and 14 GPs (non‐dyadic), recruited from 19 primary care practices.

Methods
Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives.

Results
Three main themes were identified. Within these, subthemes from patients’, GPs’, or shared patient/GP perspectives emerged. The main themes encompassed the following: (1) Change from normal – the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GPs’ knowledge was often not reflected in patients’ accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated.

Conclusions
Some findings, such as impact, mirror those described in chronic fatigue. New insights into early‐stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re‐presenting. These highlight the need for better communication and shared understanding. GPs should pre‐emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests.



Statement of contribution
What is already known on this subject?



  • Patients with chronic fatigue retrospectively report lack of understanding from GPs in early stage of illness.
  • Little research has investigated the early stages of the fatigue trajectory.


What does this study add?



  • Consequences of an episode of subacute fatigue are similar to those reported for CFS.
  • There is discordance between GPs’ positive view of negative tests and patients’ need for explanation of symptoms.
  • The length of appointments is a significant barrier for creating shared understanding.
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if we replace 'fatigue' with 'cough', 'itch', etc - this study remains equally meaningless,
because a common symptom can have a multitude of different biomedical causes.

do UK doctors still do differential diagnosis - or is that superceded by a BPS pamphlet,
and being sent home to think positive ?
 
More useless fun and frivolity from RM-M via SLaM, KCL, and NIHR. Again with the negative test results mean psychological attribution. This idea needs to be put down.

The main point of note I'm beginning to think is that it didn't cost much to do.
And can be massaged to mean just about anything you want.

I think what needs to happen is a better understanding of money allocation and it's real or imagined utility.
I wonder if it is real savings in the short run to psychologise fatigue or if that's an illusion. Certainly I think in the long term it cannot hold.

I think this is the main argument that matters to those who hold the purse for allocating money to those who then fund this sort of thing. The main concern of places like SLaM is of course continued existence and growth and making what they do seem like it's highly reputable.
 
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