Open Access Highly Accessed Research article

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

Kerin Bayliss1*, Mark Goodall2, Anna Chisholm3, Beth Fordham3, Carolyn Chew-Graham4, Lisa Riste1, Louise Fisher5, Karina Lovell6, Sarah Peters7 and Alison Wearden7

Author Affiliations

1 Institute of Population Health, University of Manchester, Manchester, UK

2 Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK

3 Institute of Inflammation and Repair, University of Manchester, Manchester, UK

4 Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, UK

5 National School for Primary Care Research, University of Manchester, Manchester, UK

6 School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

7 School of Psychological Sciences, University of Manchester, Manchester, UK

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BMC Family Practice 2014, 15:44  doi:10.1186/1471-2296-15-44

Published: 7 March 2014



The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.


A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.


Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.


In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.

Chronic fatigue syndrome/ME; Barriers and facilitators; Management and diagnosis; Qualitative research; Primary health care