Date sent:      	Fri, 25 Jan 2002 

Can General Practitioners Manage Chronic Fatigue Syndrome? A Controlled
Trial. [Preliminary Study]

J of Chronic Fatigue Syndrome, Vol. 10( 1) 2002, pp. 55-64

Lisa Whitehead, MA, BSc (Hons) RGN; Peter Campion, PhD, FRCGP,
MRCP (UK), DCCH

Lisa Whitehead is affiliated with The Health and Community
Care Research Unit, University of Liverpool.
Peter Campion is affiliated with the Department of Primary Care Medicine,
University of Hull.

This work was undertaken at the Department of Primary care. University of
Liverpool.

Address correspondence to: Ms. Lisa Whitehead, The Health and Community
Care Research Unit, Thompson Yates Building, Quadrangle, Brownlow Hill,
Liverpool, L69 3GB.

The authors would like to thank Professor R. H. T. Edwards (formerly
Professor of Medicine) and Dr. Rhiannon T. Edwards (formerly Health
Economist. Department of Public Health), at the University of Liverpool
for their contributions to the study.

Grant from the NHS R&D Executive North Thames


ABSTRACT.
Background: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)
is now recognised as a condition that results in substantial disability
with a prevalence of around 0.6%.

Aim: The study aimed to test the hypotheses that general practitioners
could (a) diagnose and (b) treat patients with the Chronic Fatigue
Syndrome (CFS).

Method: All practices in two health authorities were contacted with a 35%
uptake. Fifty percent of practices then entered a patient into the study.
Practices were randomised to either intervention or control groups, and
were encouraged to recruit patients. It was intended that the
intervention practices would introduce a form of brief cognitive
behavioural therapy. Control practices were invited to manage their
patients as usual, which often included referral to secondary care.

Results: The study suffered from both poor recruitment and high drop out.
However, we were able to show that this intervention had no effect on the
illness of the patients enrolled, and that patients with CFS remained
highly disabled over the 12 month study period, whatever their treatment.

Conclusion: The study suggests that general practitioners in this study
were unable to effectively treat the condition. This accords with the
Royal Colleges' report (1996), that the only evidence for effective
treatment thus far has come from specialist units. The study suggests
that general practitioners are unable to provide a management programme
of this nature, and possibly effective treatment programmes for CFS in
primary care.


KEYWORDS. Chronic Fatigue Syndrome, primary care, management


INTRODUCTION

Fatigue is a common symptom in the general population, and in primary
care. When it persists for more than six months, and is not explained by
another medical diagnosis, and provided certain other conditions are met,
then the term "Chronic Fatigue Syndrome" (CFS) can be applied (1 ,3,4).
Various explanatory models exist, viral (5), immunological (6),
physiological (7) and psychological (8). Recent consensus reviews have
concluded that the condition can be defined, albeit only clinically,
since there are no known biological markers, and it may be considered as
the final common path from a range of triggering and perpetuating
influences in susceptible individuals.

The general practitioner (GP) is usually the first point of contact for
patients, and is faced with the dilemma of a patient for whom all
investigations are normal but who is experiencing severe symptoms. Work
and family relationships are often disrupted: 25% of people with CFS in
one study described themselves as regularly bedridden, shut-in or unable
to work (9). In addition to the physical distress experienced,
considerable psychological distress is also likely to be experienced
(10). Few sufferers receive a prompt diagnosis, and for some the repeated
discounting of symptoms by health care professionals led to frustration,
anger and self-doubt, while the making of a firm diagnosis was in itself
therapeutic (11).

There has been a growing emphasis upon the responsibility of the Primary
Care Team in the diagnosis and management of people with CFS, from
Wessely's (12) suggestion of "simple rehabilitative strategies," based on
cognitive behavioural therapy, to the Royal Colleges' report, which
states that "the management of CFS is first and foremost the
responsibility of the Primary Care Team" (1). Thus assessing general
practitioners' ability to undertake the diagnosis and management of CFS
is an important step in assessing the capacity within primary care to
undertake this role.

© 2002 by The Haworth Press, Inc. All rights reserved.


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