News | Wednesday, 29th July 2020
Better relationships are key to improving ME patients’ experience of visiting their GP
Researchers analysed results data from a survey of people with the condition
Better communication between GPs and patients is central to building trust and improving the experience of people with ME when they go to see their doctor, a university study has found.
Researchers found effective communication and more training for medical practitioners is needed to improve the doctor-patient relationship and ensure the effective delivery of care for people with myalgic encephalomyelitis (ME), a condition characterised by fatigue lasting at least six months that is unmitigated by rest.
People living with ME, which is also known as chronic fatigue syndrome (CFS), can feel a lack of support from their doctor because there can be scepticism within the medical profession about whether ME is a true illness, an ongoing debate within the field.
Results
In research published in BMC Family Practice, a team from Manchester Metropolitan University analysed data from a nationwide survey of more than 470 patients with ME about their experiences of primary care.
The survey was carried out by Healthwatch Trafford - the independent health and social care services watchdog for the borough of Trafford in Greater Manchester - in response to an individual with the condition's experience.
Lead study author Dr Stephen Walsh, Senior Lecturer in Psychology at Manchester Metropolitan University, said: “A significant proportion of people with ME reported unsatisfactory relationships with their GP, and we wanted to try to understand the factors behind this by examining the Healthwatch Trafford data.
“We found approximately half of respondents did not trust their GP, and those who trusted their doctor were more likely to visit more often.
“This is important as a lack of trust can dissuade patients from attending their surgery as often as they would like, and this has a knock-on impact on clinicians being able to properly manage their condition.”
One in 250
Previous unrelated research extrapolated data to suggest about one in every 250 people in the UK has the symptoms of ME.
ME is not included in part of the contract GP practices sign with the NHS, known as the Quality and Outcome Framework, and this lack of recognition is thought to lead to less incentive to provide a formal diagnosis, potentially making it more difficult for people with ME to access what they consider the correct treatment and support.
Dr Walsh said: “We found two potential barriers are depersonalisation and stereotyping.
“From the perspective of GPs, the ME patient group is viewed as problematic because an ME diagnosis is often contentious, the condition is rare and its absence from the Quality and Outcome Framework disincentivises GPs from making a formal diagnosis.
“These factors combine to make ME management and treatment challenging and time consuming.”
Formal diagnosis
The Manchester Metropolitan study found no evidence that a patient with a formal diagnosis attended their GP more regularly but it did confirm that in general the longer someone was living with ME the less frequently they saw the doctor.
Male patients were less likely to make appointments than female patients and Dr Walsh and his co-authors recommended doctors be encouraged to challenge gender stereotypes around GP engagement to reach out and engage with their male patients.
Research co-author Dr Andrew Denovan, Senior Lecturer in Psychology at Manchester Metropolitan University, said: “Our findings reveal that over time ME patients engage less with medical practitioners.
“Although the reasons for this are currently unclear, our findings suggest that improved doctor and ME patient communication and monitoring is advisable.
“This would help to track the number of appointments attended, their frequency, and the points at which attendance ceases.”
Engaging with treatment
He added: “Maintaining and engaging with treatment is vital to condition management and well-being.
“A general remedy for ineffective communication is to provide empathic, personalised and coordinated support from health and social services.
“We can make healthcare better by improving the relationship between clinicians and their patients.
“Overall, it is hoped that the study findings can inform a range of salient and potentially crucial social relationships and interactions that affect the lives of those living with ME.
“Significant groups include the clinical two-person grouping of GP and patient, gender groups, the patient group and the position of those living with ME in relation to wider society, such as employers and social welfare.”
Impact
The Manchester Metropolitan research team’s study was a more extensive follow-up analysis of the same survey data that they had first examined to enable Healthwatch Trafford to produce an initial report in response to the original patient complaint.
Andrew Latham, Chief Officer of Healthwatch Trafford, said: “We gathered experiences from people with ME/CFS to find out what issues they were facing in the way they were treated because of the condition.
“The response we had was much bigger than we anticipated, showing the strength of feeling on the condition.
“We are glad that this data has been useful and hope that this further analysis of the experiences we gathered can help drive improvement in the way those with ME/CFS can access services and treatment.
“The report contributed to the National Institute for Health and Care Excellence reviewing its guidelines on ME/CFS, which is a very positive outcome.
“Unfortunately, this work has been put back due to the current pandemic and is now scheduled for next year."
Dr Walsh and Dr Denovan’s co-authors on the study were Manchester Metropolitan University colleagues Dr Neil Dagnall, Reader in Applied Cognitive Psychology and Dr Kenneth Drinkwater, Senior Lecturer in Cognitive and Parapsychology.
