Making the diagnosis of Chronic Fatigue Syndrome/Myalgic Encephalitis in primary care: a qualitative study.
BACKGROUND
NICE guidelines emphasise the role of the primary care team in the management of patients with Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME). A key stage in effective management is making an accurate early diagnosis, supported by appropriate referral.


METHODS
A nested qualitative study within a multi-centre randomised controlled trial which aimed to explore GPs' views on their role in making the diagnosis of CFS/ME and subsequent management of patients in primary care. Semi-structured interviews with 22 GPs. Interviews were transcribed verbatim and an iterative approach used to develop themes from the dataset.


RESULTS
GPs described difficulties in defining CFS/ME and suggested that their role in making a diagnosis was to exclude physical causes for the patient's symptoms, but they reported little confidence in positively attributing the label of CFS/ME to a patient and their symptoms. GPs suggested that the label of CFS/ME could be potentially harmful for the patient. The role of referral to secondary care was debated and GPs struggled defining their own role in management of this group of patients.


CONCLUSIONS
Until GPs feel comfortable making the diagnosis of CFS/ME and facilitating initial management, and have appropriate services to refer patients to, there will continue to be delays in confirming the diagnosis and patients presenting in primary care with fatigue may not receive appropriate care.


BACKGROUND
ISRCTN 74156610.
Chew-Graham
Carolyn
C
Primary Care Research Group, School of Community-Based Medicine, University of Manchester, Manchester, UK.
Dowrick
Christopher
C
Wearden
Alison
A
Richardson
Victoria
V
Peters
Sarah
S
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D042241:Early Diagnosis; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D006801:Humans; D010348:Patient Care Team; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D036301:Qualitative Research; D012017:Referral and Consultation; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires