LETTER
The Chronic Fatigue Syndrome
John H. Dodge, MD, and
Michael W. Kita, MD
1 July 1995 | Volume 123 Issue 1 | Pages 74-76
TO THE EDITOR:
The recent article on the chronic fatigue syndrome by Fukuda and colleagues [1] improves the clinical framework for viewing what seems to be an etiologically diverse group of disorders that vary in their course (severity, duration, and completeness of recovery). When the authors, citing two studies, inform readers that "some persons afflicted by the chronic fatigue syndrome improve with time" but "most remain functionally impaired for several years," readers may equate "functionally impaired for. years" with chronically disabled.
We do feel that many physicians are doing their patients a disservice by emphasizing the extent of disability possibly attributable to the syndrome. We believe that the physician who, on making a diagnosis of the syndrome, automatically tells his or her patient to cease working is doing a disservice to that patient. Such an action can lead to an unfulfilling life of dependency that denies the patient the value of employment and family and community activities. Those who are encouraged to do little more than rest are cut off from those actions that our society has traditionally viewed as providing satisfaction and meaning in one's life.
Among those whose level of impairment because of the syndrome has made them eligible for disability benefits under private insurance coverage, our experience has been that the best functional outcomes have occurred for those whose motivation and expectations have been guided by case-management strategies of optimism, activity prescription, and early return to at least part-time work.
We believe that patients with the chronic fatigue syndrome should be encouraged to adapt to their illness and to pursue as fulfilling a life as they are able. Physicians can do a great service to their patients through supportive, caring therapy and vocational rehabilitation when needed, an approach that concentrates on returning patients to a productive role in their community. We hope that such an outcome is an important goal of all physicians caring for persons with the chronic fatigue syndrome.
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Author and Article Information
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UNUM Life Insurance Company of America; Portland, ME 04122
1. Fukuda K, Strauss SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A, and the International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994; 121:953-9.
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