title: Using multiple sources of knowledge to reach clinical understanding of chronic fatigue syndrome.
abstract: OBJECTIVE
  Chronic fatigue syndrome (CFS), or myalgic encephalitis (ME), is a contentious condition and often a diagnosis of exclusion. Current policy in the United Kingdom recommends management in primary care. We explored how patients with CFS/ME and family physicians understand this condition and how their understanding might affect the primary care consultation.
  
  
  METHODS
  We undertook a qualitative study with patients and family physicians from North West England participating in a primary care-based randomized controlled trial (FINE Trial). Data were collected through purposive sampling and in-depth semistructured interviews with 24 patients and 14 family physicians. We analyzed interview transcripts using constant comparison methods.
  
  
  RESULTS
  Family physicians access social and cultural knowledge to reach a clinical understanding of CFS/ME and its management. Patients recognize the difficulties family physicians encounter in understanding their symptoms and access similar nonclinical sources of information. We suggest that both patients and physicians use biomedical discourse within the consultation: the physician to maintain the position as an expert, the patient to engage the physician.
  
  
  CONCLUSIONS
  Family physicians obtain information about CFS/ME from their nonprofessional world, which they incorporate into their professional realm. Patients and physicians describe the use of the discourse of science within consultations about CFS/ME. This form of shared understanding could lead to a positive collaborative interaction. Family physicians need a biomedical, evidence-based knowledge about CFS/ME. There is potential to use the rich knowledge base that patients can bring to consultations in training initiatives directed at family physicians.
authors.affiliation: School of Community-Based Medicine, University of Manchester, Manchester, UK. carolyn.chew-graham@manchester.ac.uk
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
authors.forename: Greg
authors.initials: G
authors.lastname: Cahill
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.forename: Alison
authors.initials: A
authors.lastname: Wearden
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015673:Fatigue Syndrome, Chronic / Q000523:psychology* / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D036301:Qualitative Research; D035501:Uncertainty