UK Medical Education
Healthcare professionals urgently need accurate education and training that reflects the reality of ME as a complex multi-system disease.
Medical education on ME in the UK is often lacking or contains erroneous information. We are working towards a world in which healthcare professionals immediately understand the severity of ME, and the basics of how to treat and manage it.
With the 2021 National Institute for Health and Care Excellence (NICE) ME/CFS guideline published, we have a real opportunity to improve medical education, and therefore the care of people with ME in the UK.
This is a paradigm shift. All people with ME should now be advised to stay within their current energy limits. Graded exercise therapy should not be recommended, nor should therapies based on the Lightning Process. It is so important for health professionals to understand this shift, and work to ensure any advice they give is in line with the new guidance.
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Doctors with ME
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This is an area of our work that we are developing and want to grow further. If you have ideas, knowledge or skills to share and want to join our volunteer team on this, contact us today.
Key points from the UK's ME guideline
Severity
People with mild ME care for themselves and do some light domestic tasks (sometimes needing support) but may have difficulties with mobility. Most are still working or in education, but to do this they have probably stopped all leisure and social pursuits. They often have reduced hours, take days off and use the weekend to cope with the rest of the week.
People with moderate ME have reduced mobility and are restricted in all activities of daily living, although they may have peaks and troughs in their level of symptoms and ability to do activities. They have usually stopped work or education, and need rest periods, often resting in the afternoon for 1 or 2 hours. Their sleep at night is generally poor quality and disturbed.
People with severe ME are unable to do any activity for themselves or can carry out minimal daily tasks only (such as face washing or cleaning teeth). They have severe cognitive difficulties and may depend on a wheelchair for mobility. They are often unable to leave the house or have a severe and prolonged after-effect if they do so. They may also spend most of their time in bed and are often extremely sensitive to light and sound.
People with very severe ME are in bed all day and dependent on care. They need help with personal hygiene and eating, and are very sensitive to sensory stimuli. Some people may not be able to swallow and may need to be tube fed.
Diagnosis
In the UK, ME should be diagnosed in a child, young person or adult who has the symptoms below that have persisted for 3 months and are not explained by another condition.
ME should be suspected in people who have all of these symptoms for at least 4 weeks when they aren’t explained by another condition.
When ME is suspected, people should be advised:
- not to use more energy than they perceive they have − they should manage their daily activity and not ‘push through’ their symptoms
- to rest and convalesce as needed (this might mean making changes to their daily routine, including work, school and other activities)
- to maintain a healthy balanced diet, with adequate fluid intake.
Debilitating fatigue that is worsened by activity, is not caused by excessive cognitive, physical, emotional or social exertion, and is not significantly relieved by rest.
Post-exertional malaise after activity in which the worsening of symptoms:
- is often delayed in onset by hours or days
- is disproportionate to the activity
- has a prolonged recovery time that may last hours, days, weeks or longer.
Unrefreshing sleep or sleep disturbance (or both), which may include:
- feeling exhausted, feeling flu-like and stiff on waking
- broken or shallow sleep, altered sleep pattern or hypersomnia.
Cognitive difficulties (sometimes described as ‘brain fog’), which may include problems finding words or numbers, difficulty in speaking, slowed responsiveness, short-term memory problems, and difficulty concentrating or multitasking.
Key areas of information and advice
Health and social care organisations should ensure that people with ME can use their services by:
- adapting the timing, length and frequency of all appointments to the person’s needs
- taking into account physical accessibility, such as how far the person has to travel, whether there is suitable transport and parking, and where rooms are for appointments
- taking into account sensitivities to light, sound, touch, pain, temperature extremes or smells
- providing care flexibly to the person’s needs, such as by online or phone consultations or making home visits.
People with ME should be given tailored information about their illness. It should be explained that:
- ME is a fluctuating condition
- the long-term outlook varies from person to person, but many will need to adapt to living with ME/CFS
- ME can be worsened by particular triggers
- ME can involve flare-ups and relapses even if symptoms are well managed, so planning for these should be part of the energy management plan.
People with ME should be signposted to support groups, given advice on financial and social support, and access to aids and adaptations.
Health profressionals should recognise that people with ME/CFS may have experienced prejudice and disbelief and could feel stigmatised by people (including family, friends, health and social care professionals, and teachers) who do not understand their illness.
They should involve families and carers (as appropriate) in discussions and care planning if the person with ME chooses to include them. They should also be aware that ME affects everyone differently and its impact varies widely – for some people symptoms still allow them to carry out some activities, whereas for others they cause substantial incapacity. It’s important to understand this is a fluctuating illness.
Energy Management
Energy Management is the key management approach for all people with ME. It’s a long term approach, that aims to help people learn to use the amount of energy they have while reducing their risk of post-exertional malaise or worsening their symptoms by exceeding their limits.
People with ME should be supported to develop and energy management plan, that takes into account all the activies they do – including both physical and cognitive activites.
The new guideline clearly states that health professionals should “work with the person to establish an individual activity pattern within their current energy limits that minimises their symptoms.”
A specialist physiotherapist or occupational therapist may be helpful for some people.
People with ME should be provided with further advice, support and treatments to manage different symptoms.
Our Aims
Knowledge
To ensure that healthcare professionals have access to the most recent information and training on the diagnosis, management and care of people with ME in the UK.
Do No Harm
To make professionals aware of the dangers of incrementally increasing activity levels for people with ME, and that pacing is the best management strategy.
Understanding
To build widespread understanding and acknowledgement of the debilitating nature of ME.
Events and Modules
#MEAction UK Continuing Professional Development (CPD) events
#MEAction UK worked hard to get in-person screenings of Unrest certified for CPD. Due to the pandemic this had to be postponed but we aim to hold events in the future.
Online Module for GPs launched by Dr Nina Muirhead
This free one-hour course contains a wealth of information, including how to diagnose the illness, the dangers of exercise, common comorbidities, and best practice in caring for people with ME. It also touches on the coronavirus pandemic and the possibility that it will trigger ME in a subset of those who survive COVID-19.
We urge people to share this module with their GPs using our email template.
GET INVOLVED
We need more volunteers to expand and develop our work around medical education – is this something that interests you? If so, contact us today.
You can also follow us on social media for regular updates on all our work.