Almost half (49%) of all patients referred to a specialist CFS service in London during 2007-8 did not have a diagnosis of CFS. Thirty-seven percent of referrals, screened by both a psychiatrist and a physician, were declined at the point of referral, sometimes for more than one reason, of which 61% were for likely alternative medical and psychiatric diagnoses. A further 46% of patients assessed did not receive a diagnosis of CFS…
The commonest alternative medical diagnoses of those assessed were sleep disorders and the commonest alternative psychiatric diagnosis was depressive illness…
… this paper replicates two previous studies finding high rates of misdiagnosis in patients accepted and assessed in a secondary care CFS service. The NICE guideline suggests that patients with CFS should be diagnosed and managed in primary care, and specialist CFS services used for patients with severe and disabling symptoms. Our results suggest that this may not be the best guidance. These results have implications for training, care pathways and service design, particularly in primary care and those specialist services without a doctor. Specialist services need doctors who are equally confident in making both medical and psychiatric diagnoses.
