Monday, 4 March 2013

Chronic Fatigue - I'm a believer

Although chronic fatigue does not strictly fall under immunology, one of the consultants in the department has a special interest in chronic fatigue. When he offered me the chance to sit in on one of his clinics I can't say that I was particularly excited, I thought I was in for a boring afternoon. The truth was far from it, I actually enjoyed my time in the clinic and came out with a very different viewpoint of chronic fatigue.

Before this episode I thought that chronic fatigue, or Myalgic Encephalopathy, was fictitious or at best psychiatric in origin. I had seen a few patients with mild disease attending their GP surgery, but otherwise had not really seen any of these patients. I had thought that these people were time wasters who were squandering public money by using up resources which could be better spent elsewhere. I don't think that this is dissimilar to what many in both the medical profession and the wider public think.

So as you can tell I was a little sceptical before the clinic. After seeing a few patients I was pleasantly surprised. These weren't the whining, lazy, emotional cohort I was expecting. Just normal people who one day had started feeling more tired than normal. As the clinic went on there were a couple of people that did fit into the whining category, but they were in the vast minority and maybe it was just because they had suffered for such a long time.

At the end of the clinic the consultant gave me a little teaching session. He informed me that ten years ago he diagnosed 10% of the patients referred to him as chronic fatigue with an organic condition. Five years ago it was 40% and now he diagnoses almost 75% with an organic condition. I found this astounding and asked him what had changed. His answer was not to do with the patient demographic changing, or the change in modern society and lifestyles, but purely because he had gained more experience and was now able to spot and investigate more subtle diagnoses.

Even for the patients who are given a diagnosis of chronic fatigue there is now a chronic fatigue service. Which combines physiotherapy, patient education and psychology input. Even though the disease still comes with a large social stigma, these people are able to start working again and engage with their families better by using the coping strategies.

So all in all this is a disease with a known set of symptoms, a list of differential diagnoses and a management plan; just like any other disease. Even if we are not be able to perform any investigations or prove any organic cause it, we can still help these people. Of course there are people who do not want to be helped or exaggerate their symptoms, but name one medical speciality where you can't find patients like that.

I know this is a controversial subject and lots of people have very strong feelings, so let me know what you think below.

1 comment:

  1. Sounds like a fantastic consultant. There seems to be a split, even at a high level in medicine, but I am a strong believer as well, and have a few friends with the condition. I guess the main problem is that, because it is so hard to 'prove', it is a condition that attracts people who are intentional malingerers, as they can use it as an excuse when they do not want to work (or want to fulfil their sick role in any-which-way). This is a real shame, as those who genuinely suffer from the condition then lose out, as they can be seen as malingerers too!


I look forward to hearing your thoughts and will endeavour to get back to you