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Chronic Fatigue Syndrome and the Biopsychosocial Model: Reports of Harm in the Medical Encounter

Keith Geraghty

[Thesis].Manchester University;2015.

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Abstract

Myalgic Encephalopmyelitis (ME) or Chronic Fatigue Syndrome (CFS) is the name given to an illness that may affect more than 250,000 people in the United Kingdom. ME/CFS is most often characterised by the cardinal symptoms of fatigue, pain, cognitive impairment and sleep dysfunction. Unlike other illnesses, ME/CFS remains a contested illness domain with no proven aetiology. In addition, there are conflicting models to explain the disease. More broadly, fatigue is a major presenting complaint in general practice and significant numbers of patients present to hospital and community medicine with unexplained symptoms. There has been strong impetus to tackle conditions with unexplained symptoms utilising a biopsychosocial model (BPS). The BPS model is promoted as an important tool for dealing with patients with conditions such as ME/CFS. Despite the BPS model moving medical practice away from the narrow bio-pathological focus, to include wider social and psychosocial aspects of illness, ME/CFS patients report high levels of dissatisfaction around doctor-patient encounters: many report feeling traumatised or harmed by interactions with doctors who challenge their symptoms and illness experience. This narrative review seeks to account for the possible reasons for patients reporting negative accounts of doctor-patient interactions. Outcomes from this review suggest harm and patient dissatisfaction may be tentatively linked to a number of areas of medical practice, these include: where doctors challenge patients’ understanding of their illness aetiology and symptomology; where doctors promote treatments that are rejected by patients; or where doctors do not fully involve the patient (individual or collective group) narrative and experience. This review identifies a number of potential modalities of iatrogenesis within the medical encounter and concludes that the current BPS approach to the treatment and management of ME/CFS is too narrow in focus and fails to adequately incorporate the patient perspective. As a result, conflict and harm are possible outcomes where the illness remains contested and where doctor and patient perspectives remain incongruent. Iatrogenic harm might be minimised by adopting a more patient-friendly approach.

Bibliographic metadata

Type of resource:
Content type:
Type of thesis:
Author(s) list:
Degree type:
Master of Public Health
Publication date:
Institution:
Total pages:
78
Table of contents:
ContentsList of Tables, Figures, and Exhibits 3List of Abbreviations 4Abstract 5Declaration 6Intellectual Property Statement 6Acknowledgements 7About the Author 8Introduction 9Study Aims: 10Chapter 1: ME/CFS Research 11Historical Context 11ME/CFS – An Overview of the Disease 13Epidemiology 13Aetiology 14Diagnosis and Symptomology 15A Comparison of Explanatory Models: Psychosomatic versus Biomedical 18Somatisation and the Psychosocial Model 18The Biomedical Model 19Abnormal Response to Infectious Agents Model 21CNS Sensitatisation Hypothesis 24Summary 24Chapter 2: The Theoretical and Empirical Basis of Iatrogenesis 25Fitness to Practice and Safeguarding Patient Safety in the UK 25Iatrogenesis in the NHS 26Harm in Primary Care 27Psychological Harm 30Harm at the Population and Society Level 32Chapter 3: Methodology 34Chapter 4: ME/CFS the Medical Encounter and Doctor-Patient Relationship 37‘The Difficult Patient’: with Unexplained Symptoms 37The Biopsychosocial Model and Patients with ME/CFS 40The Biopsychosocial Model in the NHS and Clinical Practice 41Evidence of Iatrogenic Harm within the Biopsychosocial Approach in ME/CFS 43Controversial Treatment Guidelines for ME/CFS in the UK 50Summary 54Chapter 5: Discussion and Conclusions 55An Alternative Pragmatic Patient-Centred Approach 58Limitations of this Review 60Future Research and Recommendations for Clinical Practice 60References: 62Appendices 71
Abstract:
Myalgic Encephalopmyelitis (ME) or Chronic Fatigue Syndrome (CFS) is the name given to an illness that may affect more than 250,000 people in the United Kingdom. ME/CFS is most often characterised by the cardinal symptoms of fatigue, pain, cognitive impairment and sleep dysfunction. Unlike other illnesses, ME/CFS remains a contested illness domain with no proven aetiology. In addition, there are conflicting models to explain the disease. More broadly, fatigue is a major presenting complaint in general practice and significant numbers of patients present to hospital and community medicine with unexplained symptoms. There has been strong impetus to tackle conditions with unexplained symptoms utilising a biopsychosocial model (BPS). The BPS model is promoted as an important tool for dealing with patients with conditions such as ME/CFS. Despite the BPS model moving medical practice away from the narrow bio-pathological focus, to include wider social and psychosocial aspects of illness, ME/CFS patients report high levels of dissatisfaction around doctor-patient encounters: many report feeling traumatised or harmed by interactions with doctors who challenge their symptoms and illness experience. This narrative review seeks to account for the possible reasons for patients reporting negative accounts of doctor-patient interactions. Outcomes from this review suggest harm and patient dissatisfaction may be tentatively linked to a number of areas of medical practice, these include: where doctors challenge patients’ understanding of their illness aetiology and symptomology; where doctors promote treatments that are rejected by patients; or where doctors do not fully involve the patient (individual or collective group) narrative and experience. This review identifies a number of potential modalities of iatrogenesis within the medical encounter and concludes that the current BPS approach to the treatment and management of ME/CFS is too narrow in focus and fails to adequately incorporate the patient perspective. As a result, conflict and harm are possible outcomes where the illness remains contested and where doctor and patient perspectives remain incongruent. Iatrogenic harm might be minimised by adopting a more patient-friendly approach.

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University researcher(s):

Record metadata

Manchester eScholar ID:
uk-ac-man-scw:298648
Created by:
Geraghty, Keith
Created:
13th March, 2016, 22:10:45
Last modified by:
Geraghty, Keith
Last modified:
13th March, 2016, 22:10:45

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