title: Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies.
abstract: BACKGROUND
  The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.
  
  
  METHODS
  A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.
  
  
  RESULTS
  Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.
  
  
  CONCLUSIONS
  In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.
authors.affiliation: Institute of Population Health, University of Manchester, Manchester, UK. kerin.bayliss@manchester.ac.uk.
authors.forename: Kerin
authors.initials: K
authors.lastname: Bayliss
authors.forename: Mark
authors.initials: M
authors.lastname: Goodall
authors.forename: Anna
authors.initials: A
authors.lastname: Chisholm
authors.forename: Beth
authors.initials: B
authors.lastname: Fordham
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
authors.forename: Lisa
authors.initials: L
authors.lastname: Riste
authors.forename: Louise
authors.initials: L
authors.lastname: Fisher
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.forename: Alison
authors.initials: A
authors.lastname: Wearden
mesh_terms: D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000628:therapy*; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care; D036301:Qualitative Research