Chronic Fatigue Syndrome and the Biopsychosocial Model: A Review of Harm in the Medical Encounter

Myalgic Encephalopmyelitis (ME) or Chronic Fatigue Syndrome (CFS) is the name given to an illness that may affect more than 250,000 people in the United Kingdom. ME/CFS is most often characterised by the cardinal symptoms of fatigue, pain, cognitive impairment and sleep dysfunction. Unlike other illnesses, ME/CFS remains a contested illness domain with no proven aetiology. In addition, there are conflicting models to explain the disease. More broadly, fatigue is a major presenting complaint in general practice and significant numbers of patients present to hospital and community medicine with unexplained symptoms. There has been strong impetus to tackle conditions with unexplained symptoms utilising a biopsychosocial model (BPS). The BPS model is promoted as an important tool for dealing with patients with conditions such as ME/CFS. Despite the BPS model moving medical practice away from the narrow bio-pathological focus, to include wider social and psychosocial aspects of illness, ME/CFS patients report high levels of dissatisfaction around doctor-patient encounters: many report feeling traumatised or harmed by interactions with doctors who challenge their symptoms and illness experience. This narrative review seeks to account for the possible reasons for patients reporting negative accounts of doctor-patient interactions. Outcomes from this review suggest harm and patient dissatisfaction may be tentatively linked to a number of areas of medical practice, these include: where doctors challenge patients’ understanding of their illness aetiology and symptomology; where doctors promote treatments that are rejected by patients; or where doctors do not fully involve the patient (individual or collective group) narrative and experience. This review identifies a number of potential modalities of iatrogenesis within the medical encounter and concludes that the current BPS approach to the treatment and management of ME/CFS is too narrow in focus and fails to adequately incorporate the patient perspective. As a result, conflict and harm are possible outcomes where the illness remains contested and where doctor and patient perspectives remain incongruent. Iatrogenic harm might be minimised by adopting a more patient-friendly approach.