After 30 years in General Practice, I’m now retiring and will be spending more time on my area of special interest of chronic fatigue.
This blog tells the tale behind how this interest developed and covers a number of factors that shape the pattern of our lives. Why do we do what we do? Who has encouraged and supported us to get there? What has been the spur to follow things through?
I can say exactly when my interest in chronic fatigue was aroused and how it impinged on my clinical practice.
When I was a resident – as we were called in those days – in 1979, I was working for Dr RW Strachan,(see left) Consultant Physician in the Infirmary. A patient was admitted with an illness where fatigue was a major symptom. Dr Strachan considered that this could be “Royal Free Disease”. This was named after the London hospital where much research had been undertaken into the illness which would become known as ME – myalgic encephalitis. Dr Strachan encouraged me to investigate thoroughly the patient and write up a report to send to the Royal Free.
The lessons learned from this exercise stayed with me and I began to note symptom patterns consistent with what is now called ME-Chronic Fatigue Syndrome in patients I saw in general practice.
One thing led to another. I was invited to meet with the local support group. One of my patients met with Thea Stein, our then Director of Planning, and I was asked to be clinical lead for ME-CFS.
This has taken me down a very interesting road over the years and has opened many doors. To mix my metaphors, it has not always been plain sailing. ME-CFS is an ill understood condition. There has been great debate and difference of opinion. It is a multi-factorial condition that can affect many systems in the body. It is characterised by fatigue and particularly post exertional fatigue. It is also characterised by joint and muscle pains, sleep disturbance and cognitive problems often termed “cognitive fogging” where people report that their ability to think things through can be lost through fatigue. There are bowel symptoms akin to irritable bowel syndrome.
We will all have experienced the fatigue after a viral illness and the time taken to recover fully from it. In some people that recovery does not seem to take place. Post viral fatigue is the commonest cause but there are other triggers which will need to be better identified.
Having seen patients in my practice who were fit and well and suddenly see a change in their functioning level after the index viral illness, I do believe that there is, as yet an unknown mechanism that triggers this condition. This can make a profound difference to people’s lives.
At one end of the spectrum there are the me-sceptics who do not believe that there is a physical element to the illness. There are patient groups who are certain that their illness is purely physical with no emotional or psychological element. Once when I spoke as a GP that I aimed to practice medicine holistically, I was told that that meant that I did not believe that ME was a physical illness and the holistic care was a way of doctors saying that it was a psychological illness.
In general, though, this road has been positive and very interesting and allowed me to become involved in research and development at a level unimaginable to me when I entered general practice.
What has been achieved? There is now much more awareness of the condition. I find that when I speak to friends and colleagues, often there is a keenness to speak about someone they know with the condition. I’ve had the privilege through Alex Fergusson MSP, to bring this condition to the attention of the Scottish Parliament. I have developed links with both local support groups. I have a good working relationship with ME Research UK. This is a Perth based charity which supports biomedical research into this condition. I work with both the ME Association and Action for ME. These are two national charities which provide patient support and lobbying. They also provide a great deal of support to clinicians.
The biggest piece of work to date has been the Scottish Good Practice Statement on ME-CFS. Why a good practice statement? There is not the evidence to satisfy the requirement of a SIGN Guideline. There was a need to produce a document for clinicians in Scotland. We felt that the document, as well as giving guidance, had to reflect controversies over forms of treatment such as graded exercise and CBT.
It has been exciting to work with Action for ME in the development of educational packages. I’ve been introduced to the world of webinars. Now I know what it is like to read the news on the telly!
Locally, it has been great to work with clinical colleagues especially in physiotherapy looking at what we can provide in Dumfries and Galloway Professor Isles has also taken a keen interest in this area.
Back to the title! Like many, I’ve been blessed during my career by consultants and GPs who took an interest in the young pup. Dr Strachan’s encouragement has taken me down this clinical pathway which has shaped my career.
It behoves us similarly to enthuse and encourage to-day’s youngsters in the same spirit. It could become a greater legacy than could originally have been predicted.
Gregor Purdie is a General Practitioner for NHS Dumfries and Galloway