General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study
Firstly, as a doctor with personal experience of this genuine and
very disabling illness, I have encountered many of the negative
observations expressed by my colleagues who participated in this study.
And even though there are now many more who do not share their views, the
media quickly picked up the negative stereotyping of ME/CFS patients to
produce yet more unhelpful publicity about 'work-shy' individuals who were
'lacking in motivation' (1). Having failed to provide any proper balance
by referring to evidence which does not support these views, or relevant
conclusions contained in the 2002 Chief Medical Officer's report into
ME/CFS, the authors should not be suprised to find that their paper has
been very badly received by the ME/CFS patient community (2).
Secondly, as a Trustee of The ME Association, I believe that the
authors have seriously misunderstood the role of charities working in this
difficult area of medicine. Yes, The ME Association campaigns and we
recently presented around 30,000 signatures on a petition to the Prime
Minister which called for urgent government-funded research into the
physical cause of this illness - something which the Medical Research
Council has so far refused to acknowledge as being of high priority. But
The ME Association also plays a vital role in providing information to
doctors, patients and researchers in the absence of any official sources
taking a lead. In addition, we are actively involved with the Department
of Health initiative to fund new clinical services for people with ME/CFS.
Finally, as a doctor who likes to receive balanced information in the
British Medical Journal, I was concerned at what appears to be a clear
bias by the authors in favour of the psychosomatic explanation for ME/CFS.
For example, they conclude that: 'For chronic fatigue syndrome and
irritable bowel syndrome, effective management includes discussion about
mental health interventions, particularly for patients who have responded
poorly to other management interventions'. Yet the Department of Health
and World Health Organisation both now accept that ME and CFS should be
classified as neurological disorders under section G93.3 in the current
International Classification of Diseases (ICD 10). Would the authors
conclude that a patient with multiple sclerosis who was responding poorly
to treatment should then be referred to the mental health services? I
think not.
Rapid Response:
Turning the clock back on ME/CFS
Editor -
Firstly, as a doctor with personal experience of this genuine and
very disabling illness, I have encountered many of the negative
observations expressed by my colleagues who participated in this study.
And even though there are now many more who do not share their views, the
media quickly picked up the negative stereotyping of ME/CFS patients to
produce yet more unhelpful publicity about 'work-shy' individuals who were
'lacking in motivation' (1). Having failed to provide any proper balance
by referring to evidence which does not support these views, or relevant
conclusions contained in the 2002 Chief Medical Officer's report into
ME/CFS, the authors should not be suprised to find that their paper has
been very badly received by the ME/CFS patient community (2).
Secondly, as a Trustee of The ME Association, I believe that the
authors have seriously misunderstood the role of charities working in this
difficult area of medicine. Yes, The ME Association campaigns and we
recently presented around 30,000 signatures on a petition to the Prime
Minister which called for urgent government-funded research into the
physical cause of this illness - something which the Medical Research
Council has so far refused to acknowledge as being of high priority. But
The ME Association also plays a vital role in providing information to
doctors, patients and researchers in the absence of any official sources
taking a lead. In addition, we are actively involved with the Department
of Health initiative to fund new clinical services for people with ME/CFS.
Finally, as a doctor who likes to receive balanced information in the
British Medical Journal, I was concerned at what appears to be a clear
bias by the authors in favour of the psychosomatic explanation for ME/CFS.
For example, they conclude that: 'For chronic fatigue syndrome and
irritable bowel syndrome, effective management includes discussion about
mental health interventions, particularly for patients who have responded
poorly to other management interventions'. Yet the Department of Health
and World Health Organisation both now accept that ME and CFS should be
classified as neurological disorders under section G93.3 in the current
International Classification of Diseases (ICD 10). Would the authors
conclude that a patient with multiple sclerosis who was responding poorly
to treatment should then be referred to the mental health services? I
think not.
Charles Shepherd
References
1 Doctors unsympathetic to ME patients, research finds. Society
Guardian 28 May 2004. Available on-line at:
http://society.guardian.co.uk/health/story/0,7890,1227016,00.html
2 The MEA criticises new CFS/IBS paper in BMJ. MEA website announcement
28 May 2004. Available on-line at:
http://www.meassociation.org.uk/fwhats_new.htm
Competing interests:
Person with ME/CFS who has no psychiatric co-morbidity
Competing interests: No competing interests