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Annals of Family Medicine 6:340-348 (2008)
© 2008 Annals of Family Medicine, Inc.
doi: 10.1370/afm.867
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Using Multiple Sources of Knowledge to Reach Clinical Understanding of Chronic Fatigue Syndrome

Carolyn A. Chew-Graham, MD, FRCGP1, Greg Cahill, MSc2, Christopher Dowrick, MD, FRCGP2, Alison Wearden, PhD3 and Sarah Peters, PhD3

1 School of Community-Based Medicine, University of Manchester, Manchester, UK
2 Division of Primary Care, University of Liverpool, Liverpool, UK
3 Division of Psychology, University of Manchester, Manchester, UK

CORRESPONDING AUTHOR: Carolyn A. Chew-Graham, MD, FRCGP, 7th Floor, Williamson Bldg, Oxford Rd, Manchester M13 9PL, United Kingdom, carolyn.chew-graham{at}manchester.ac.uk

PURPOSE 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.

Key Words: Chronic fatigue syndrome • myalgic encephalitis • primary health care • models of illness • doctor-patient relationship




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TRACK Comments:

Read all TRACK Comments

Communication between doctors and patients withCFS
Jos WM van der Meer MD PhD FRCP, et al.
Annals of Family Medicine, 16 Jul 2008 [Full text]
Using multiple sources of knowledge to reach clinical understanding of Chronic Fatigue Syndrome
Carl R May
Annals of Family Medicine, 16 Jul 2008 [Full text]
Medical care free of science and based on social networks
Peter D White
Annals of Family Medicine, 23 Jul 2008 [Full text]
Care based on Social Networks because of Misrepresentation?
Ian T McLachlan
Annals of Family Medicine, 4 Aug 2008 [Full text]
Negotiating the label of CFS
Carolyn Chew-Graham, et al.
Annals of Family Medicine, 13 Aug 2008 [Full text]
Educating the medical profession is the key
John R. Anderson
Annals of Family Medicine, 26 Sep 2008 [Full text]

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