Growing up, I always loved going to my family friends’ house and visiting the nicest aunty who would greet us with a smile and boundless affection. Yet, even during our joyous visits, there was an unspoken weariness in her eyes, which only became clear when I learned about her long battle with a chronic condition during medical school, a few years after my grief at her passing.
The puzzle pieces fell into place – the infrequency of visits, the choice of her house as the meeting place to minimise exertion, and the perpetual fatigue that belied her relatively young age.
Myalgic encephalitis, commonly known as chronic fatigue syndrome, is a chronic and multisystemic disease with a complex pathophysiology. Despite its association with conditions like post-treatment Lyme disease and long COVID, the specific cause remains elusive. Previous and ongoing research delve into its link to viral infections,1 genetic factors2 and environmental triggers such as mould exposure and metal hypersensitivities.3 Rapid advancements in research, fuelled by increased interest in long COVID, have unveiled new biomarkers and mechanisms, fostering hope for future breakthroughs.
While research progresses, clinical challenges persist. The National Institute for Health and Care Excellence guideline 206 now provides defined diagnostic criteria, a crucial step forward.4 However, historical diagnostic hurdles persist due to a lack of familiarity among clinicians. Many healthcare professionals, having received little or no education on myalgic encephalitis/chronic fatigue syndrome (ME/CFS) during their training, face challenges in recognising and understanding the condition.5 Negative preconceptions and scepticism further hinder prompt diagnosis.6
Complicating matters, the association between ME/CFS and conditions like postural tachycardia syndrome and fibromyalgia, also poorly understood and viewed unfavourably by some clinicians, further leads to negative perceptions within the healthcare community of ME/CFS itself.
Managing ME/CFS demands a personalised approach. Patients often endure a traumatic journey, consulting numerous doctors before receiving a diagnosis.7 What has particularly inspired me thus is the role of clinicians specialising in ME/CFS who employ effective listening skills, respect and trust to build person-centred relationships with their patients.8 This empathetic approach, crucial for managing a condition with such diverse and often misunderstood symptoms, serves as a model for clinicians across specialties.
The landscape of ME/CFS is gradually unfolding, revealing both the strides made in research and the persistent challenges in clinical understanding. As we anticipate further breakthroughs, fostering awareness and education of both the public and clinicians at every level of training is essential in improving the lives of those grappling with the complexities of ME/CFS.
My most important learning point about ME/CFS, however, is how it really exemplifies that the best doctors are the ones that listen and form a relationship with patients. ME/CFS is often a truly debilitating chronic condition, and it is imperative for us as clinicians to recognise this and understand how it impacts the patient’s life, not just dismiss it because it is complex with an incomplete knowledge base.
Just like my aunty, there is a person behind the condition. Their suffering is real, even if we do not yet fully understand it.
Bhanu Wahi-Singh
Source: Journal of the Royal College of Physicians, Edinburgh – open access
The ME Global Chronicle 