Neighbourhood ME/CFS care should energise GPs

Copperfield on why the biggest winners from ME/CFS clinics might be GPs, not patients

Well, that’s interesting. Apparently, those new neighbourhood health services they have these days are going to support the delivery of ME/CFS care.

So let’s think. That means an illness of unknown cause, with no diagnostic test, no specific pharmacotherapy and no clear consensus around management strategies is going to be supported by an NHS organisational structure which is currently conceptual rather than actual, run by staff as yet undiscovered, in neighbourhood health centres that at this point don’t exist.

Which makes me think that, if depression isn’t already a feature of ME/CFS (another controversy), then it soon will be.

Although, to be uncharacteristically doctor-centric, maybe I’m missing the point. Perhaps the main beneficiaries of clinics like these – actual or speculative – are not the patients, but us GPs.

Because, to be brutally frank, I can’t think of a single patient who has returned from a referral to a CFS clinic, a Long Covid Clinic, a fibromyalgia assessment or the CBT wing of a pain clinic – each for that ‘holistic’ approach so important in these cases – and said, ‘That was really positive/helpful/constructive’. It just doesn’t happen. And for ‘holistic’, read: stuck in a hole.

There may be many reasons for this:

1. Perhaps I only see, post clinic-input, the dissatisfied and disenfranchised. Maybe there are, in fact, many patients with CFS/Long Covid/fibromyalgia/chronic pain who are discharged from their respective outpatients so transformed that they never feel the need to return to me with a ‘What a waste of time that was, now what?’ expression on their face.
2. Human nature being what it is, patients are hoping for an FP10 magic bullet, which obviously a feckless GP can’t/won’t prescribe but maybe a proper specialist will. And instead, they get lots of talky-talky/walky-walky stuff. They go with hopefulness, they get mindfulness and they return to give me earfulness.
3. GPs go all telesales and overegg what these clinics can realistically provide and what they can actually achieve.

Maybe it’s a combo of all three. But to be honest, none of us believe ‘1’, ‘2’ is partially correct, and ‘3’ is a massive and inconvenient truth. Of course we oversell these services. For one thing, we’ve by definition reached an impasse, or we wouldn’t be referring, so we have to kid ourselves it might achieve something. And for another, if we don’t big-up the clinic, the patient might not attend.

All of which means I’m complicit in a system whereby I peddle an illusion of hope to the patient, while relishing the reality of the temporary relief referral gives me. Which I think means I’m knowingly fobbing the patient off to give myself a break. Which in turn means I’m appalling. But it’s easier to be appalling than to explain to patients that medicine can’t cure everything. If only there was a clinic that could do that for us.

Dr Tony Copperfield is a GP in Essex