BMJ  2004;328:1354-1357 (5 June), doi:10.1136/bmj.38078.503819.EE (published 28 May 2004)

Primary care

General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

¹ Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ² Imperial College of Science, Technology and Medicine, West Middlesex University Hospital, Isleworth TW7 6AF

Objectives To compare general practitioners' perceptions of chronic fatigue syndrome and irritable bowel syndrome and to consider the implications of their perceptions for treatment.

Design Qualitative analysis of transcripts of group discussions.

Participants and setting A randomly selected sample of 46 general practitioners in England.

Results The participants tended to stereotype patients with chronic fatigue syndrome as having certain undesirable traits. This stereotyping was due to the lack of a precise bodily location; the reclassification of the syndrome over time; transgression of social roles, with patients seen as failing to conform to the work ethic and "sick role" and conflict between doctor and patient over causes and management. These factors led to difficulties for many general practitioners in managing patients with chronic fatigue syndrome. For both conditions many participants would not consider referral for mental health interventions, even though the doctors recognised social and psychological factors, because they were not familiar with the interventions or thought them unavailable or unnecessary.

Conclusions Barriers to the effective clinical management of patients with irritable bowel syndrome and chronic fatigue syndrome are partly due to doctors' beliefs, which result in negative stereotyping of patients with chronic fatigue syndrome and the use of management strategies for both syndromes that may not take into account the best available evidence.

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