Chronic fatigue syndrome key
I refer to the article 'How to deal effectively with chronic fatigue syndrome' (Pulse Registrar, January 27).
There certainly isn't any need in most cases to wait for symptoms to persist for six months before making a diagnosis of ME/CFS as patients require a great deal of help with management well before this time.
And there are also people with ME/CFS who do not have four or more of the additional 'minor' symptoms that appear in the CFS research diagnostic criteria.
Although it is important to neither under- or over-investigate patients with a possible diagnosis of ME/CFS, the key to making sure that other possible explanations for their symptoms (eg, hepatitis C infection, SLE, multiple sclerosis) have been excluded comes from (a) taking a detailed clinical history,
(b) pursuing any unusual symptom or one of the 'minor' symptoms if particularly prominent, eg, joint pain in relation to SLE, (c) following up abnormalities on routine screening tests which are not consistent with ME/CFS actions that should really be taken as soon as the diagnosis is queried.
In order to establish a good working relationship with ME/CFS patients there is no point in getting into disputes about what to call the illness and whether it is physical or psychological in origin.
Dr Charles Shepherd
Medical adviser, ME Association