**1. Introduction**

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, multisystem illness defined by its clinical characteristics rather than by its underlying pathology, which remains obscure. These characteristics include severe incapacitating fatigue, post exertional malaise and other symptoms including cognitive dysfunction, orthostatic intolerance, muscle pain and sleep disturbances, with substantial reductions in functional activity and quality of life [1]. The severity, clinical course and duration of the illness are very variable. It most frequently occurs in the 20–50 age group and is more common in women than in men [2–4]. It is frequently asserted that there are some 250,000 sufferers

**Citation:** Hng, K.N.; Geraghty, K.; Pheby, D.F.H. An Audit of UK Hospital Doctors' Knowledge and Experience of Myalgic Encephalomyelitis. *Medicina* **2021**, *57*,885. https://doi.org/10.3390/ medicina57090885

Academic Editor: Saraschandra Vallabhajosyula

Received: 21 July 2021 Accepted: 24 August 2021 Published: 27 August 2021

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in the UK [5]. If this is correct, there may be in the region of two million patients across Europe and over one million sufferers in the US [6].

A major problem faced by patients with ME/CFS is that many doctors do not recognise the condition as a genuine clinical entity. Disbelief is widespread, and many doctors lack knowledge and understanding of the illness. A recent literature review found that between a third and a half of GPs refused to accept the reality of the condition, that a similar proportion of patients were dissatisfied by the quality of primary care that they had received, and that similar proportions were reported across various geographical locations and had changed little over many years [7]. A study of the perceptions of European ME/CFS specialists concerning GP knowledge and understanding of the illness demonstrated serious misgivings about shortcomings, widely across Europe [8], and this is confirmed by a German paper that reported low satisfaction with medical care and that patients with ME/CFS are medically underserved [9]. It is also consistent with reports that individuals with ME/CFS in the US are medically underserved [10]. It has been argued that ME patients suffer delegitimation of their illness experience through their condition being defined as nonexistent or psychosomatic, leading to their being shamed or stigmatised as having a psychological disorder [11]. A US survey of emergency department attenders with ME/CFS found that 42% of such attenders were dismissed as having psychosomatic problems, and that staff lacked knowledge of the condition [12], while another American survey of patients with ME/CFS and other diseases of the neuro-endocrine-immune system including fibromyalgia and chronic Lyme disease found that 54.4% of respondents reported dissatisfaction with their medical care due to lack of training on the part of their physicians. In total, 71% consulted four or more physicians, and 63% took at least two years, before receiving a correct diagnosis, indicating a need for more education about these conditions in medical school, and for multi-system disease specialty clinics [13].

In this paper, the term ME (myalgic encephalomyelitis) is used in reporting our research findings, rather than the more usual ME/CFS, because that was the term used in the original training session on which this report is based. The term ME/CFS is used in reporting the relevant research literature, as the two terms are effectively synonymous.

As outlined above, it has long been the experience of patients with myalgic encephalomyelitis (ME) that their doctors have little knowledge and understanding of the condition and are largely unable to help. Worse, many report that their doctors do not believe their illness is real, resulting in lack of medical support. Examination of sample medical curricula in 2018 in the UK confirmed that ME was not in the syllabus at either undergraduate or postgraduate levels, and this is consistent with a report demonstrating serious inadequacies in undergraduate teaching about ME/CFS, in which 64% of responding medical schools acknowledged the need for improvement [14], and also with an earlier report from the US in which only 28% of responding medical schools met an adequate standard of coverage in their curricula [15].

It is therefore quite conceivable that patients' widely reported impressions are well founded, so to investigate this, we undertook an ad hoc opportunistic audit of hospital doctors' knowledge and understanding. This study appears to be the first attempt in the United Kingdom to assess knowledge and understanding of ME among a group of hospital doctors.
