Chapter Two, Course WB1032
Tips for Managing Appointment Times
- Set a schedule of appointment times to assure your patient that there will be regular opportunities to discuss symptoms and assess progress. This may help build a trusing relationship. It may also decrease the number of non-essential phone calls to the office between visits.
- When developing a management plan, concentrate first on the most troubling symptom as voiced by your patient. When feasible, make a pact with your patient to focus the greatest amount of attention on one symptom at a time (e.g., get to the bottom of sleep problems and find therapies that help, then move on to the next symptom).
- Provide brief assessment tools that track the frequency and severity of symptoms (e.g., sleep, pain, cognition), functional impairment and ability to meet ADLs and general activity levels and mental health status. Have the patient complete these at home and bring with them to the schedueld appointment. These not only document progress or relapse, but also provide documentation of disability. A quick review of these tools at the bieginning of the appoint brings you up-to-date on their status over the past weeks and minimizes the need for a routine history every visit.
- Ask your patient to bring an updated list of medications with each visit, requesting that they highlight any additions since their last visit, including OTC drugs and supplements.
- Utilize allied health treatment providers to offer psychological support as well as physical, mental and occupational rehabilitation.
Management of CFS
The objective of an effective CFS management program is to relieve symptoms, improve function and quality of life and to mobilize hope, helping the person with CFS set realistic goals and expectations. Effective management is also the rationale for identifying the patient with CFS.
Often, people with CFS were highly active, productive individuals before they became ill. Helping patients adjust their expectations to the limitations imposed by CFS can help reduce negative feelings of stress, anxiety or anger, all of which can exacerbate symptoms. Health care professionals are encouraged to assist people with CFS to understand that hope for improvement is realistic, but immediate and complete restoration of pre-illness functioning is not the initial emphasis of therapy. Although no specific intervention has been shown to cure or to lead to resolution of CFS, multidisciplinary approaches leading to adaptation have been shown to reduce symptoms and improve quality of life. Approaching the illness from this perspective may help individuals initially cope better with the frustration of living with CFS and ultimately facilitate effective self-management and symptom improvement.
Ideally, a multidisciplinary team of health care professionals (e.g., physicians, physician assistants, nurse practitioners and other primary care professionals, mental health professionals, rehabilitation professionals) working together to develop an individualized, coordinated care plan would best serve the patient. Realistically, ongoing coordination of care is difficult to achieve, given financial, time and logistical constraints. However, health care professionals who are responsible for overall or component management are encouraged to use recommendations provided by other disciplines and to contact health care professionals who may be receptive to coordinated care.
All CFS management strategies must be individually developed, with each patient’s particular abilities, needs and concerns at the forefront. An individualized treatment plan optimally includes two components: supportive and symptomatic management. Both of these will be addressed in detail.
A complete history and physical will often take more than the standard 10 -12 minute office visit. Recognizing your time limitations, written assessment tools that measure fatigue intensity, functional disability, sleep problems or mental health concerns can be given to the patient to fill out between visits or upon early arrival to the office.
Health care professionals might consider using tools to assess frequency and severity of individual CFS symptoms and their combined impact on function. Several instruments have been developed, adapted and/or validated for CFS, including:
- CDC Symptom Inventory (Wagner et al., 2005) and SF-36 (Ware and Sherbourne, 1992) are comprehensive, validated instruments.
- Multidimensional Fatigue Inventory (MFI) (Smets et al., 1995) is a 20-question assessment of the broad impact of fatigue on quality of life over the prior month.
- The Wong-Baker FACES Pain Rating Scale (Hockenberry et al., 2005) is a well-validated tool for documenting pain. Visual analog scales and verbal rating scales are widely accepted for documenting pain and other criteria, such as fatigue or symptom severity.
- Bell’s Disability Scale (Bell, 1995) and the Subjective Functional Capacity Assessment (Lapp, 1993) were developed by physicians for use in the clinical setting to quickly document patient status at each visit.
A combination of the CDC Inventory, the SF-36, and the MFI may also be helpful in diagnosing the syndrome (Reeves et al., 2005). Additional information about these tools is included in 
Appendix A (PDF – 150KB).
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Content Source: National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ZVED)