title: Chronic fatigue syndrome--a patient centred approach to management.
abstract: BACKGROUND
  Chronic fatigue syndrome (myalgic encephalomyelitis) is a diagnosis that can attract feelings of stigma in the patient due to the lack of a definite diagnostic biomarker. To ensure that the patient firstly understands the diagnosis, and subsequently is comfortable with the treatment suggested, a patient centred approach is advised within the consultation.
  
  
  OBJECTIVE
  This article presents a hypothetical case and uses this to give guidance on methods for negotiating the diagnosis and treatment of chronic fatigue syndrome.
  
  
  CONCLUSIONS
  It is important to reassure the patient that negative investigation results and the suggestion of treatment options that are also used for depressive illness (eg. antidepressants and cognitive behavioural therapy), does not mean that their illness experience is fabricated or that they are being treated for depression. Once red flag features are ruled out and any exclusory illnesses identified, a multidisciplinary pragmatic rehabilitation program can be implemented. This includes strategies for increasing social support, liaising with employers and graded return to activities in a 'What matters to you?' approach.
authors.affiliation: The Optimum Health Clinic, Research Department, London, England. drarroll@theoptimumhealthclinic.com
authors.forename: Megan
authors.initials: M
authors.lastname: Arroll
authors.forename: Bruce
authors.initials: B
authors.lastname: Arroll
mesh_terms: D003142:Communication; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D010347:Patient Care Planning; D010817:Physician-Patient Relations