For my fourth year medical school research project, I reviewed the process of assessment and diagnosis of CFS/ME within primary and secondary care.
It raised some interesting questions about the issues of diagnosing these disorders in primary care and how GPs can help these patients even with limited time and resources.
The diagnosis of CFS or ME relies on extensive history-taking and recognition of a characteristic pattern of symptoms. Four hallmark features are: post-exertional malaise, (‘payback’ where intense, prolonged exhaustion occurs after activities which used to be normal for the patient), cognitive difficulties (‘brain fog’), sleep disturbance and chronic pain.
The distinction between chronic fatigue and CFS/ME can be hard to establish in a ten-minute GP appointment. NICE guidance includes the dreaded phrase that GPs are ‘well placed’ to provide early assessment and diagnosis for patients. However, my placement in a specialist CFS/ME centre highlighted the intensive evaluation of patients that takes place there and therefore the challenges of making a definitive diagnosis in primary care.
So what can a GP do for these patients? Before a diagnosis has been established, GPs can help patients with individualised advice on managing their symptoms including sleep hygiene, therapeutic rest, and relaxation techniques on initial consultation.
GPs can also help these patients by making the referral as detailed as possible. The referral should ideally contain a narrative of the patient’s symptoms, findings from examination, results of routine investigations and previous medical reports. This will speed up diagnosis and allow patients to get treated sooner.
At the end of my project, I came up with some ideas to easily improve the diagnosis of CFS and ME. I suggested creating a new referral form to make the transfer of information from referee to receiver more efficient and a patient information leaflet to be given to patients on referral to provide early symptom management advice. Hopefully this will help patients get the best care and make it easier for GPs to manage these patients.
