AHMF: Conf 2001: DP Lewis

Management of Patients Presenting with CFS at Primary Care Level

DP Lewis

Contact: Medical Choice Specialist Centre
275-277 Burwood Highway
East Burwood
Melbourne 3151
Australia

This paper describes how to address the difficulty that exists in obtaining an adequate and representative history when those with CFS present initially. Obvious hindrance relates to the patients' health in having both physical and cognitive limitations, and the complexity of the presentation.

This can be effectively addressed with preliminary assessment of the patients' history and analysis of response to a symptomatic questionnaire prior to the initial consultation.

The history is obtained as a written response to three questions, requesting information related to the onset of their illness, a description of events that occurred at that time, and features of their current health.

The response to the Questionnaire demonstrates the significance of the symptoms experienced by the patient on presentation. It provided an indication of the current clinical picture and assisted in the implementation of a treatment strategy. It also served as a baseline against which one can assess response to treatment.

This study involved nearly 400 people over a two year period.

The analysis was firstly of the demographic details of those presenting.

This analysis was to show the relative incidence of those who presented for attention in both sexes, the age in which this illness occurred and the duration of the illness at the initial presentation.

The computer analysis of the response to the symptomatic questionnaire graphically represented the current symptom profile, showing the degree of alteration to:

mood
sleep disturbance
fatigue
cognitive dysfunction
gastro-intestinal symptoms
neurological/musculo-skeletal symptoms.

Further analyses were done by a number of the same patients to demonstrate the response to the treatment strategies that were employed.

Analysis of all the studies at initial presentation demonstrated:

a greater number of females presenting
that approximately equal occurrence of symptoms occurred in each sex
that all age groups are represented, though there are some peaks that presented
that there is an order of presentation, such order being most commonly

sleep disturbance
fatigue
cognitive dysfunction
neurological
mood changes
gastro-intestinal

that such order is the same for whatever sex, age, duration of illness.

This assessment was felt by both the doctor and the patient to have been an accurate representation of the current clinical condition, an invaluable aid for the introduction of further management and a means of continued assessment of the progress.