Using Multiple Sources of Knowledge to Reach Clinical Understanding of Chronic Fatigue Syndrome

被引:37
作者
Chew-Graham, Carolyn A. [1 ]
Cahill, Greg [2 ]
Dowrick, Cbrislopber [2 ]
Wearden, Alison [3 ]
Peters, Sarah [3 ]
机构
[1] Univ Manchester, Sch Community Based Med, Manchester, Lancs, England
[2] Univ Liverpool, Div Primary Care, Liverpool L69 3BX, Merseyside, England
[3] Univ Manchester, Div Psychol, Manchester, Lancs, England
基金
英国医学研究理事会;
关键词
Chronic fatigue syndrome; myalgic encephalitis; primary health care; models of illness; doctor-patient relationship;
D O I
10.1370/afm.867
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE Chronic fatigue syndrome (CFS), or myalgic encephalitis (ME), is a contentious condition and often a diagnosis of exclusion. Current policy in the United Kingdom recommends management in primary care. We explored how patients with CFS/ME and family physicians understand this condition and how their understanding might affect the primary care consultation. METHODS We undertook a qualitative study with patients and family physicians from North West England participating in a primary care-based randomized controlled trial (FINE Trial). Data were collected through purposive sampling and in-depth semistructured interviews with 24 patients and 14 family physicians. We analyzed interview transcripts using constant comparison methods. RESULTS Family physicians access social and cultural knowledge to reach a clinical understanding of CFS/ME and its management. Patients recognize the difficulties family physicians encounter in understanding their symptoms and access similar nonclinical sources of information. We suggest that both patients and physicians use biomedical discourse within the consultation: the physician to maintain the position as an expert, the patient to engage the physician. CONCLUSIONS Family physicians obtain information about CFS/ME from their nonprofessional world, which they incorporate into their professional realm. Patients and physicians describe the use of the discourse of science within consultations about CFS/ME. This form of shared understanding could lead to a positive collaborative interaction. Family physicians need a biomedical, evidence-based knowledge about CFS/ME. There is potential to use the rich knowledge base that patients can bring to consultations in training initiatives directed at family physicians.
引用
收藏
页码:340 / 348
页数:9
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