Date sent:      	Mon, 1 Oct 2001 

Chronic Fatigue Syndrome: Overcoming the Attitudinal Impasse

J of Chronic Fatigue Syndrome, Vol. 8. No. 3/4. 2001. pp. 53-61

E. Stein, MD FRCP(C)

Affiliation: E. Stein is Staff Specialist in Psychiatry, Community
Adolescent Team, The Junction, New South Wales. He is also Lecturer in
Psychiatry, University of Newcastle, Callaghan, New South Wales.
Address correspondence to: E. Stein, c/o Community Adolescent Team, 36
Kenrick Street, The Junction, NSW, 2291 Australia (E-mail:
mailto:aupsych@bigpond.com ).

SUMMARY.
Context: Patients with Chronic Fatigue Syndrome and their physicians are
often in conflict about the etiology and treatment of CFS.

Objectives: 1. Survey the literature regarding physician's attitudes
towards CFS; 2. Examine the contributing factors to physician's attitude
towards the disorder; and 3. Suggest solutions.

Data Sources: The relevant medical and psychological literature (years
1988-2000) was searched using the search term "Chronic Fatigue Syndrome."
This was supplemented with papers from the bibliographies of the
retrieved papers, additional related literature, and clinical experience.

Data Synthesis: Forty-six to ninety percent of GPs accept CFS as a
discrete clinical entity and 30-82% are willing to make the diagnosis in
qualifying patients.

Conclusions: CFS is a heterogeneous, multifactorial host response
disorder that is inadequately described by the biomedical model. Despite
substantial evidence of multisystemic physical abnormality in CFS, the
lack of pathognomic tests and the female gender predominance cause some
physicians to continue to treat CFS as a psychosocial disorder. This
leads to conflict between patients and physicians. CFS challenges
physicians to think beyond current disease models, to tolerate diagnostic
and therapeutic uncertainty, and to work collaboratively with patients
rather than taking the role of expert.


KEY WORDS. Attitudes, etiology, diagnosis


INTRODUCTION
Despite a large and growing evidence of immune, endocrine, autonomic and
cognitive dysfunction in CFS, a precise understanding of CFS etiology and
mechanism has not yet been reached (1). Inadequate definition, the
heterogeneous presentation of patients with CFS and physician's
discomfort with disorders which do not conform to a linear biomedical
model have contributed to uncertainty among physicians as to the
legitimacy of CFS as a discrete medical entity. Many physicians continue
to formulate and treat CFS as a psychosocial disorder. Patients, on the
other hand, believe their problems to be primarily of physical origin and
are dissatisfied with treatment that does not address physical issues.
The objective of this paper is to review the literature about physician's
attitudes towards CFS, to examine the contributors to these attitudes and
to suggest solutions to the current impasse

Quantitative data was gathered through a search of the literature
(MEDLINE and PSYCHLIT 1988-2000) using the search term "Chronic Fatigue
Syndrome" in it. All abstracts (n > 1500) were searched. The full text of
all relevant papers was retrieved. The bibliographies of the retrieved
papers and the full holdings of the Journal of Chronic Fatigue Syndrome
(not in Medline) were searched by hand. This paper is not intended as a
thorough review of the etiology or treatment of CFS but does include
relevant examples to highlight useful conceptions and some of the common
misconceptions about the disorder.


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